Getting a D in Health

Greetings, indoor, computer-reader.

The Sunbathing Ape

It's natural for us to feel drawn to amazing photographs of sun-soaked landscapes. We humans evolved as mostly-naked, outdoorsy folks in sunny Africa. Although the cultures (and to some degree the genes) of migrating peoples have done what they can to adapt to more polar environments, if you dig at all deep into our biology you'll see we still aren't fine-tuned to live indoor, boreal lives.

One of the biologically unmet expectations humans in the USA and Canada experience is low sun exposure, leading to Vitamin D deficiency. This article in the Globe and Mail suggests that Canadians typically have about one third of optimal concentrations of vitamin D in their bloodstream.

What's D Good For?

Until recently, it was thought that the major effect of vitamin D deficiency was rickets. Since (last time I checked) rickets wasn't an endemic problem to North Americans, vitamin D was seen as being a non-issue; the mandated additions of D and A to dairy products seemed to be sufficient to keep bone formation normal in children.

However, vitamin D has more functions than merely the regulation of bone density. It's also an important chemical precursor to a lot of important cellular signaling mechanisms: not having sufficient vitamin D is the equivalent of trying to run a government when there's a shortage of notepads to write on.

D and Cancer Rates

One of the worst consequences of screwing up chemical messages is to impede natural anti-cancer cellular mechanisms. Does our D-prived culture result in fact in increased cancer rates? The only way to know for sure is with a double-blind experiment where groups are given vitamin D and placebos at random, and to track prevalence of cancers in the two groups. That's exactly what this study did, and what they found is almost unbelievable. Giving 1.5g supplemental Calcium with 1100 IU per day (about 3 liters of milk worth, but the study used pills) decreased cancer rates by 77% after one year.

Great moons of Neptune! That's a huge decrease! The cautious part of me finds it hard to believe that one factor could be responsible for over half of cancers, and to be fair the study tracked only 1200 women over 4 years, and thus wasn't able to notice enough cases of cancer to have really tight confidence intervals: the range of cancer decreases still consistent with the study is 91%-40% 19 times out of 20. Still, I've started feeding vitamin D to my wife as well as taking it, if not daily, than at least often.

Public Health Consequences

Suppose the study's numbers bear up, and that about half of cancers could be prevented by 1100 IU of vitamin D per day. Would it be a good policy for health insurers (or friendly socialist governments like Canada's) to simply hand out vitamin D supplements? It looks like the cost of vitamin D is pretty much nothing: this bottle of 250 pills (almost a year's supply) with 1000 IU of vitamin D is only $10. On the flipside, the annual cancer rate in the US is 1 in 200. If that could be halved by the D supplement, and if treatment costs on average $40 000, that's an expected savings of $100 per year. Pay one dollar into prevention, get 10 out in unneeded treatment. (Oh, then there's the whole increase in lifespan and quality of life issue too.)

Last Word

I suppose the cautious policy approach would be to conduct a larger study to figure out where within the wide confidence interval the truth lies. However, I'm inclined to start ramping up vitamin D production and consumption programs, maybe even with heavy subsidy by governments, HMOs or otherwise. Let's get a D in health.

How Much do You Pay Your Machines?

Greetings, Robot Lords.

The Pitch

How much do you value your free time? In Stephen King's The Stand, the Walkin' Dude comes by Mother Abigail's place in the guise of a vacuum cleaner salesman, making the pitch that he's not actually selling her labor-saving vacuum cleaners. Instead, he's selling her cool lemonade sipped in the shade on a hot day, time to lazily read a novel, or time to do essentially whatever Mother Abigail likes best. The premise is simple and appealing: we buy (or make) machines which save us drudgery, and then allegedly have more free time.

The Catch

In reality, our time-savers often end up owning us instead. It takes a lot of time, energy and money to maintain every piece of equipment we buy. On the other hand, I have a lot more free time than any subsistence farmer I've heard about, so there must be a good side to this tech too. How do we know if a given piece of labor-saving tech is worthwhile?

The Players' Salaries

One interesting analysis is to figure out what effective wage you're paying your labor saving device for your extra free time. Everything doesn't always boil down to money: it's not as if chores are equally onerous (I enjoy gardening more than cleaning the bathroom), but quantifying the hourly rate of free-time-saving makes for an interesting analysis nonetheless. Here's a summary table, then I'm going to talk a little more about some entries. Here "machine wage" isn't how much you pay per hour of operation - it's how much you pay per every hour of labor it saves you. I've ordered this list in descending order of utility.

Item	Price	Cost/y	Lifetime (y)	Hours saved/week	Hours saved	Total Cost	Machine Wage
Dishwasher	500		5	3	780	500	0.64
Non-stick fry pan	100		20	0.05	52	100	1.92
Lawnmower (electric)	400	1	10	0.25	130	410	3.15
Newer computer	1500		2	1	104	1500	14.42
Kitchen Mixer	200	1	20	0.0096	10	220	22
Melon baller	10		10	0.00064	0.33	10	30
Car	5000	2000	5	1	260	15000	57.69

• I'm a dishwasher evangelist. I've been responsible for (or at least influential in) the decisions of no fewer than 5 households I know to acquire a dishwasher by hook or by crook. (If you're renting, look into portable dishwashers - that's what I own.) Until today I just always had a hunch that dishwashers were good time-savers, but the hard numbers really nail it for me. Operating a dishwasher (in hot water and dish soap) costs about the same as washing by hand, and by my analysis my $500 dishwasher will save me 780 hours of scrubbing. Since I value my free time more than 64¢/hour, owning a dishwasher is a no-brainer.
• I just bought a $100 super-high-quality frying pan, with (I kid you not) embedded diamonds as the non-stick coating. So far I have no complaints performance-wise: I get an even heat and the food has been scrumptious every time. As a side effect, I estimate that I spend about 3 minutes per week less cleaning, since now I can use this pan instead of my older stainless steel pan (which was a pain to scrub). Those 3 minutes per week over the 20 years the pan should last amount to 52 total hours saved, so I'm "paying" this machine $1.92/hour for the privilege of not washing dishes.
  
• If I were to buy a new computer (something I dream about way too often) I might spend about 1 hour less per week waiting for my numbers to crunch (I'm a "power user": I run intensive numerical operations on a regular basis; for word-processing I doubt a newer computer would save more than a minute or two per week). If the new computer I'd keep for about 2 years, then it would save me about 104 total hours, so upgrading now (for $1500) would be like paying the machine $14.42 for every hour I save not waiting for that progress bar to end.
• I broke down and bought one of those designer kitchen mix machines the other year. We barely use it, truth be told. If it were to save 15 minutes twice a year, this $200 machine would save us 10 hours of work over its 20-year lifetime. (Inside, I doubt it will save that much time, but the truth hurts sometimes.) It really sucks power too, so I guess its lifetime cost (price + power) will be $220; meaning we're paying it $22 per hour that it saves us. (Note: this mixer brings an invaluable quantity of ancillary joy to my better half merely by gracing our kitchen - which is precisely why this kind of analysis didn't have the last word.)
• We also own a melon baller! If it saves us 2 minutes a year (we hardly use it), we're paying it $30/hour for the privilege. Maybe single-purpose kitchen gadgets should be contraband.
  
• Last (but not least) we don't own a car. I can get to and from work without one (and, considering the parking around where I work, biking is faster), even though it makes doing errands a little more tricky. I estimate I spend about 1 hour more per week doing errands because I can't just hop into a rust bucket. (Aside: if I were to offset time I don't have to spend in the gym because I bike, this 1-hour figure could very well be negative!) In any case, were I to buy a car, over 5 years it could well cost $15,000 in insurance, depreciation, maintenance, parking and fuel. For each of the 260 hours it would save me, I'd be paying it $57.69: a pretty lousy deal. I guess I won't be buying a car until my lifestyle requires one.

The Last Inning

On that note, let me hand it over to you. The numbers I've presented are highly personalized and might not apply to you. I do a lot of serious computing, and even for me a new computer only barely makes sense. I live close to work, so biking is a great option. We do a lot of entertaining, and thus a dishwasher is pretty much essential. If you truly need a car, or if you don't entertain or run scientific computing experiments your personal table is likely to be quite different. Still, I encourage you to do the same sorts of analyses before listenening to the Walkin' Dude.

Rule your 'bots with an iron fist!

LeDopore

Middle Ground Meat?

Greetings, omnivores.

Today I'm going to talk a little about animal welfare, and how we might improve it without getting angry at anyone.

Lately some animal rights protesters have been harassing someone close to me (I'm not going to go into details), and it started me thinking about ways in which animal rights activists might improve animal welfare most effectively. I think there are two main inefficiencies with current animal rights activity: extremism and lack of perspective.

Problem 1: Animal Rights Activists Tend to be Extremists

"You catch more flies with honey than you do with vinegar...*"

There are three general stances you could take on animal welfare:

1. Animals suffering is equivalent to human suffering, so feed lots are equivalent to the WWII concentration camps (reflected in some ad campaigns).
2. Animals are cute but tasty: let's try to make them reasonably happy as long as we can still eat bacon.
3. Animals are here for human use. Some animals (mosquitoes come to mind) use us without the slightest regard for our well-being, so to hell with our looking after them.

While you can legitimately defend all of the above ethically, those who take stance #1 often feel entitled to, say, bomb the houses of animal researchers. While I acknowledge that you can't "prove" any value system is right or wrong, in general it's a good idea not to espouse any belief system which tells you it's OK to murder, for practical (if not ethical) reasons.

Even if you do believe murder is justified in a few circumstances, it's bad PR to kill your enemies. Homicide undermines your soft power like nothing else. I bet the above bombing did more to inoculate potential animal rights supporters than the combined forces of all the starched-shirted science-defending geeks ever to mumble through a justification of animal use at every cocktail party the world has seen.

Problem 2: Animal Rights Groups Lack Perspective

There are over 250 million egg-laying hens in the United States: almost one per human. There are likewise millions of dairy cows and livestock pigs. Many of these animals suffer for the sake of thrift: it's cheapest to pack animals into the smallest space that won't kill them.

Still, the three biggest animal rights causes I hear about are fur, pâté de foie gras, and medical research. A more quantitative statement: a Google search for "fur activism" turns up more hits than "laying activism."

What do fur, foie gras and medical research have in common? Not everybody comes home from their day quantifying drug toxicity to grab their mink stole on their way to a nice bistro: animal rights activists figure they can win more sympathy from people to counter less-common animal uses. They even turn poverty into a virtue: most of us can't afford blue fox coats while we're starting out, but PETA would have us believe we haven't yet bought fur because we instinctively know it's wrong. Moreover, a lot of rich people feel guilty about being rich (I can treat the root of this problem, incidentally. Please leave your contact info below.), making it easier to attack the morals of self-doubting millionaires.

In short, animal rights groups attack fringe animal usage since these are the issues they think they can "win." If I were them, and if I were really interested in animal welfare, I would recognize that many of us want to reduce animal suffering and would pay to do so (at least a little), so what we really need to do is have animal rights organizations set up a scoring system for farm animal welfare.

A lot of people would pay 20¢ more for eggs from hens which suffered 50% less pain. However, we have no way of really knowing how good each farm is. The time has past (or hasn't yet come) to paint each farmer Joe as a miniature Hitler: what I'd like to see are livestock comfort ratings on beef, milk, pork, chicken and eggs. Make them fair and standardized, and just watch if you don't find a significant minority of consumers support farms that would improve the lives of tens of millions of our fellow creatures.

Conclusions

Polarizing the debate on animal usage is a losing strategy: too many of us won't give up using animals in some form. Many animal activists use terrorist tactics to intimidate minority animal users. Regardless of whether you think animal rights should be equivalent to human rights, it's a better strategy to use market forces to relieve some suffering from mainstream animal uses; that's the easiest way to reduce animal suffering overall.

Chomping tenderly,

LeDopore

Reader poll: Who's a vegetarian, and why? How much extra would you spend on your daily food knowing your meat animals suffered less? How many of you would like the taste of happy meat better, if only through the placebo effect? Please leave me comments.

* Maybe animal rights activists think of the stuck fly's suffering, and so use vinegar deliberately to warn them from the trap?

Cookie Dough: Cold Killer?

Greetings, bowl-lickers.

A friend of mine who enjoys the odd clandestine spoonful of uncooked cookie dough suggested to me last night that I look into the risks involved in his filthy habit. (Just kidding - I regularly eat raw cookie dough by the scoop.)

We're told never to eat cookie dough because raw eggs may contain the bacterium Salmonella enterica, which can make you sick. Despite all the warnings, cookie dough eating is rampant in North America. Does cookie dough cause widespread poisoning deaths, or is it just another paper tiger? Read on to find out.



Salmonellosis: Symptoms and Rates

Any medical condition with a Latin name sounds scary. However, the majority of Salmonella infections cause gastro-intestinal upset and a fever for 4 to 7 days and then go away without formal medical intervention. If you're old, an infant, or have a weak immune system, you could need antibiotics to make your infection go away, and a particularly bad Salmonella infection can cause lasting conditions like arthritis or death. However, these big-ticket fears are relatively uncommon; this CDC study says the ratio of illnesses to hospitalizations to deaths for nontyphoidal salmonellosis is roughly 2,426 to 28 to 1.

The same CDC study estimates that the number of cases of salmonellosis in the United States is about 182 000 per year, or about 1 in 1 500; but since most infections go unreported it's really hard to tell. Its best guess is that salmonellosis from shell eggs causes about 2000 hospitalizations and 70 deaths per year: in other words, salmonella from eggs is about 1000 times less deadly than the flu (from this .pdf, page 2; this comparison is apt since both flu and salmonellosis are grave threats mostly to people with compromised immune systems).

Is Cookie Dough a Big Culprit?

Most of the salmonellosis outbreaks that make the news come from large-scale slip-ups where dozens of people get ill, rather than from small families tasting the occasional batch of cookie dough. Is this just because it takes a certain number of cases before a story is newsworthy, or is there another cause at work?

This CDC page warns that in large-batch recipes where 500 eggs are used the Salmonella risk is greater, since one contaminated egg could taint the whole batch. So what's the risk of getting salmonellosis from eating cookie dough from a two-egg recipe?

This study estimates that only 1 in 30 000 eggs is potentially contaminated with Salmonella, so at most there is a 1 in 15 000 chance that your dough is going to have any Salmonella bacteria. (If the first egg doesn't have Salmonella, the second egg has a smaller than 1 in 30 000 chance of having it too, so 1 in 15 000 is an over-estimate of the risk.) Assuming that it's certain that you will catch an infection from tainted dough, that puts your risk of death from tasting the dough at less than 1 in 36 million; if you have a healthy immune system your risk is considerably smaller. The daily chance of getting a flu as bad as a non-fatal flu-like Salmonella infection are 1 in a few hundred, so you really don't need to worry about salmonella from cookie dough: background risk levels are much higher.

EDD, LED and GHAF

Let's put that 1 in 36 million figure in perspective. The Equivalent Driving Distance (EDD) is just under 2 miles (for those new here, that means a 2-mile car trip is as likely to kill you on average as eating 2 raw eggs) and the Life Expectancy Decrease (LED) is less than 37 seconds (eating 2 raw eggs decreases your life expectancy by only 37 seconds - here I assumed on average my readers might have 42 years left in life and divided by 36 million). For more on the LED and EDD risk metrics, see this introductory blog post and this wiki page for recording risk levels.

So on average the risk of being killed by your baking is negligible. But is the fear over-hyped? Considering there are 294 000 Google hits for "salmonella raw eggs America" and only 70 Americans die of Salmonella from raw eggs, the Google Hits per Annual Fatality (GHAF) hype-metric is 4 200: about as high as for West Nile virus. (See an introduction to the GHAF metric here and a list of GHAFs for various risks here.)

Conclusion: Lick On!

Eating cookie dough gives you a negligible risk unless you have a particularly weak immune system. Whip yourself up a batch and eat it all: it really doesn't matter. Oh, and please save me a spoonful while you're at it.

Bon Appetit!

LeDopore

Taking Ears Off Your Life

Greetings, colonels.

Today's post is going to look at some of the dietary consequences of US corn subsidies. The United States corn industry is politically untouchable since so many processed foods are made from corn derivatives. (If you're interested in more details about factory foods, I thoroughly recommend Michael Pollan's book The Omnivore's Dilemma.)

While many wary eaters know that corn products like corn-fed beef and high fructose corn syrup (HFCS) are wrecking dietary havoc among the American people, it's difficult to assault the entrenched food industry without convincing facts about just how much direct damage corn subsidies do to our health. In this post I'm going to show that we can blame pretty much all of our HFCS woes on corn subsidies, and I'm going to show how much damage HFCS really does.

Corn Subsidies

Ever since 1975, the United States has been paying farmers to grow corn in excess of the quantities which the market would naturally bear. Taxpayers make up the difference between the market price and a government-guaranteed price, which is often in the neighborhood of twice the buying price of corn. Americans pay over $5 billion per year (about $17 per capita) to keep farmers producing way more corn than we could ever safely consume.

Consequences of Corn Subsidies

Corn farmers aren't the ones getting rich; the net effect of corn subsidies is to ensure a huge surplus of raw biomass to be used to manufacture higher-value food products. From The Omnivore's Dilemma, I learned that about 60% of the corn grown in the United States goes to animal feed, and much of the remainder goes into producing HFCS. If you drink diet soda or if you steer clear of US-grown meat, your taxes are paying for someone else's unhealthy diet. (Show of hands: would anyone out there resent subsidizing tobacco?)

HFCS Created by Corn Subsidies

If I'm going to accuse subsidies for making us eat unhealthy corn and corn-fed meat, I'd better be sure the subsidies are actually to blame. There are three factors which make methink corn subsidies are the root cause of pretty much all the HFCS consumed by Americans. First, HFCS is cheaper than cane sugar in the US due to subsidy. Second, in Europe, where corn isn't favored like it is in North America, HFCS is almost never used as a processed food sweetener. Third, the timing of the introduction of the corn subsidy coincides with the explosive growth of HFCS consumption in the US, as is evident in this graph (from this USDA site):



Corn subsidies were introduced in 1975, before which it's plain that HFCS was a bit player. Also note that soft drinks began phasing in HFCS as a sweetener, a transformation completed by 1984. (I fancy I can see the kink in the HFCS curve around 1984 - I wonder if that's caused by saturating the soda market.)

Fat Caused by HFCS

If HFCS were like normal unhealthy food, at least a calorie of HFCS consumed would displace a calorie from some other source, meaning that HFCS wouldn't be more responsible for today's obesity epidemic than any other unhealthy food. However, as I mentioned in this post, a recent study showed that HFCS doesn't make you feel full, so consuming HFCS will not make you eat less of other things. (The 95% confidence limit to this study was that 100 HFCS calories may displace 24 other food calories, but the study's best estimate is that people actually eat 17 more calories of other foods for every 100 HFCS calories they consume. Also note that other liquefied sugars may be just as bad as HFCS at displacing other calories.)

Even if you take the most charitable view towards HFCS allowed by the study's margin of error, 76% of the HFCS calories consumed by Americans go to fat. The average annual per capita consumption of HFCS in the United States is 59 pounds. Even assuming half of that gets wasted, that means annually an extra 22 lbs of sugar per American is consumed just because HFCS happens to be today's sweetener of choice. According to this publication (page 13 - also interesting because it claims HFCS might be not worse than other liquid sugars), HFCS is about 4/9 as calorie-dense as fat, so the availability of HFCS means that on average Americans gain an extra 10 lbs per year.

Conclusion

On average, $17 of your taxes every year go to a subsidy which causes people to gain an astonishing 10 lbs per year just through the HFCS mechanism I've outlined. (I expect subsidized animal feed also makes Americans fatter, but the story there is harder to untangle.) Moreover, the over-fertilized Iowa corn monocultures are horrible on the environment, and have killed Mexican farms which can't compete with American corn prices. (Those of you who object to Mexican farm labor should throw your lot in with the anti-subsidy crowd: it's just the subsidies which enable Americans to pay migrant workers $4 an hour while just across the boarder no farmer can afford to hire at $1 an hour. It's not something magic in the soil which makes American farms magically 4 times as efficient at turning labor into food - its the subsidies.)

In conclusion, corn subsidies do enormous harm. While I haven't supported every anti-subsidy argument in this post, I've shown that without corn subsidies you'd have the equivalent weight loss of 10 lbs per year. (I suspect many Americans diet more because of their HFCS-related weight gain - imagine if you got an extra 10 lbs of "free" fat per year! Mmmm... what I'd do!)

It's going to be a tough fight against the food industry, but there are lots of good reasons to abandon our current destructive corn-driven Leviathan. Let's ditch the subsidies and let 'em howl.

Killer Cellphones?

"Pronto? MoshiMoshi? Hello?"

I was reading Digg today, which pointed me to an article speculating that cellphones are causing "colony collapse disorder," the name for an alarming phenomenon whereby the majority of honeybees in every colony are mysteriously disappearing. (By the way, this isn't jsut about the honey bees produce. The value of their crop pollination is in the billions per year; would anyone like to post a comment with a more exact figure?) The article sounded interesting until they went off the deep end by vilifying cellphones with a few cherry-picked debunked claims:

Evidence of dangers to people from mobile phones is increasing. But proof is still lacking, largely because many of the biggest perils, such as cancer, take decades to show up.

Most research on cancer has so far proved inconclusive. But an official Finnish study found that people who used the phones for more than 10 years were 40 per cent more likely to get a brain tumour on the same side as they held the handset.

Equally alarming, blue-chip Swedish research revealed that radiation from mobile phones killed off brain cells, suggesting that today's teenagers could go senile in the prime of their lives.

Chilling. Let's go into an account of how much damage a cellphone can do, and let me cite a few studies of my own.

Traffic Dangers

We have lots of evidence that cellphones impair driving ability. A University of Utah study found that cellphone conversations impair about as much as a .08% blood alcohol content, the threshold for the legal drunk-driving limit in many North American states. The World Health Organization says talking on a cellphone while driving increases your risk of accidents by a factor of 3 to 4. Taking a 100-mile drive decreases your life expectancy on average by about one hour, i.e., it has and LED of one hour (see posts with the tags LED and EDD for more, or this one which introduces them). Talking on your cellphone bumps the LED up to three or four hours, meaning that the driving-related risk starts to overcome the old-age-related risk you'd incur anyways if you call people while driving.

Other than impairing driving ability (and repetitive stress injuries from thumb-typing), cellphones aren't going to hurt you. Let's take a look first at the physics of cellphones (which will show them to be benign) and then take a look at the epidemiology of cancer among cellphone users, citing the most thorough study ever done, which happens to be Danish (Long Live Fear-Dispelling Vikings!).

The Physics of Cellphones

Cellphones communicate by broadcasting microwaves to cell towers. They use one of two frequency ranges: either about 850 MHz (the PCS band) or about 1900 MHz (the cell band). The peak power of a cellphone's transmission is about 2 Watts, so the amount it broadcasts into your head isn't more than about 1 Watt.

There are three potential concerns which make cellphones potential health risks: heat, chemical damage, and brain interference. Let's assess each potential risk.

Of Cellphones and Sunbeams

It turns out many of you non-hat wearers heat your head with electromagnetic radiation on a daily basis. A fusion-powered blob of gases over 100 million km away bakes your melon with an intensity of over 1000 Watts per square meter on a cloudless day. If the cross-sectional area of your head is about 3% of a square meter, that means the sun warms your head with over 30 times the power intensity of a cellphone. If cellphone-related heat can cause damage, so can the sun.

Mutagenic Conversations?

The next most commonly-feared etiology of cellphone-related cancer is through the photons in the microwaves causing genetic damage by affecting our DNA. However, the energy in even the highest-energy cellphone photons is far too low: a 1900 MHz photon has an energy of less than 8 microelectronvolts: about 100 000 times less energetic than the kind of photon needed to make any chemical change. At body temperature, random thermal fluctuations give every molecule constant kicks of over 25 millielectron volts: over 1000 times as powerful as a cellphone photon. No cellphone is going to turn you into a toxic avenger.

Nokia Mind Control?

I've seen one more way in which fear-mongers propose that cellphones could harm you:. They think it's possible that the pulses of electromagnetic energy could interfere with brain functions. It's true that neuroscientists use pulses of transcranial magnetic energy to temporarily (and, we hope, reversibly) poke an area of gray matter to try to figure out what it does. Could cellphones be doing the same?

Again, the relative magnitudes are way off: neuroscientists use field strengths around 10 Tesla, while cellphones typically have much smaller magnetic field strengths: around 50 Gauss or 5 mTesla (1 Tesla = 10 000 Gauss: one of those Metric System anomalies). Once again there's a yawning, factor-of-1000 gulf between the strength of a cellphone and the effect size needed to make worrying sane. It's even worse when you take into account the fact that the energy associated with a magnetic field goes as the square of the field strength, so it's more like a factor-of-1-million difference between what a cellphone is and what we'd worry about.

Epidemiology

By now, it shouldn't surprise you to find that the most extensive study done on cellphones (the Danish one I alluded to) "found no evidence for an association between tumor risk and cellular telephone use among either short-term or long-term users." The study followed 420 095 persons for up to 21 years each, and saw that cancer rates were not higher than among the population in general. Breath a sigh of relief, and don't believe the fear-mongers who say cellphones are risky.

What about studies which show a correlation between cancer and cellphone use? There's a dirty little secret in science called publication bias. In a nutshell, it's precisely those stories which seem to defy common thinking which seem most newsworthy, get the most press, and get published. In cases where there's a lot of public interest and attention, it's a good policy to disregard studies with small sample sizes, since there are probably 20 unpublished small studies with null results for every 1 study with a stunning effect that's significant at the 5% level.

Conclusions

I don't know that much about bees, but cellphones are safe to humans, provided that their attention isn't needed elsewhere and that it doesn't over-stress them to have a cellphone. It's not totally outrageous to guess bees might be confused by cellphones, since the Earth's magnetic field is only about 0.3 Gauss. I'm not an expert of bee navigation, but it shouldn't be to hard to experimentally verify the connection between active cellphones and bee death. In the meantime, color me skeptical, especially considering that the article repeats loony fears.

The Google Hype-Meter

Greetings, West Nile mosquito-swatters.

I hope that by now you will be familiar with my style of putting over-hyped risks in their place. But how do you determine how over-hyped a problem is? Today I'm going to introduce a new metric to assess how out-of-proportion a particular death threat is: the Google Hits per Annual Fatality or GHAF metric.

Google and Hype

First of all, let me admit that reducing such a nebulous idea as "hype" to a number is an inexact science at best. However, I happen to be an inexact scientist: the perfect blogger for the job.

The people who post web content are not representative of the human race as a whole, so if there's something which netizens preferentially talk about, Google is going to reflect that bias. However, in most cases this bias will distort reality by at most about a factor of 10, so any enormous differences in the whole-world hype devoted to certain risk factors should be also present in a subject's Internet chatter. Luckily, some small risks are so enormously exaggerated that even an inexact measure like the GHAF can find them with confidence.

Calculating the GHAF

So, if we're agreed that Google hits will approximate the amount of talk on a subject, we can divide the number of hits by the annual death rate of a scare to get the GHAF, a relative measure of how much that particular problem has been overblown. Let's take a look at a few real-world examples of the GHAF.

Raw Data

• Malaria in Africa (GHAF = 1.5, 3 million Google hits [1] per approximately 2 million annual deaths [2])
  
• Cancer in the United States (GHAF = 94, 54 million hits [3] per 570 280 annual deaths: page 1 of [4], .pdf warning: 6 MB)
• West Nile Virus in the United States (GHAF = 5 500, 911 000 hits [5] per 165 annual deaths [6])
• vCJD, the human disease from eating a mad cow, worldwide (GHAF = 81 000, 1.4 million hits [7] for 139 cases over 8 years [8] - see my blog entry for an editorial[9])
  
• Alligator Attacks in the United States (GHAF = 293 000, 461 000 hits [10] per 1.57 annual deaths [11] - possibly the fatality rate is underestimated by this list and possibly a lot of the Google hits came from attacks on non-human targets)
  

Summary

The GHAF hype metric has a huge variability. It is a few thousand time greater for West Nile in the US than for malaria in Africa. Working from the assumption that most human life should be treated with roughly the same degree of care, these wildly differing GHAFs indicate that we spend far too much time worrying about the wrong things. With the GHAF, we can measure just how skewed our fears are.

The above list is far from exhaustive; does anybody want to look into adding traffic deaths or killer bees? I've set up a wiki page to keep track of the GHAFs of various risks. Feel free to add to it!

In any case, there's a huge variation in how much hype a risk gets compared with the actual danger involved. I realize there are only so many articles one can read about a certain risk before becoming inured to it, so one would expect the GHAF to be lower for real risks as not as much press will go to the millionth victim as to the first. However, the number of Google hits a risk gets is not even an increasing function of associated body count, showing that our problems run deeper that just weariness over old news.

Conclusions

I've already introduced two new measures of danger, the life expectancy decrease (LED) and the equivalent driving distance (EDD). However, these measures only ask how dangerous an activity is; they do not report how much that danger has been magnified by the media. With the GHAF, we can quantify just how out-of-proportion the hype is around a certain fear, and perhaps allow this measure of exaggeration to shape policy.

I look forward to your additions to my wiki page. What will my intelligent readers discover?

Warning Labels on Soda Pt 2: the Real Risk

Greetings, fellow nerds.

Last post, I ridiculed the warnings on the side of 2 liter soda bottles; in-depth studies did not find a single instance of them causing any serious eye injury. Today I'm going to estimate your health risks once the bottle is open.

If the soda you bought wasn't diet, then it's loaded with one of American nutritionists' worst nightmares: high fructose corn syrup (HFCS). HFCS is the most common caloric sweetener in soft drinks in the United States, in part because agricultural corn subsidies make corn plentiful and cheap.

HFCS: Empty Calories Without Filling You Up

It's a real shame that corn was chosen as the US's crutch crop, because HFCS happens to be not just pure sugar, but it's a kind of stealth sugar which doesn't make you feel less hungry. HFCS calories then don't displace other calories in your diet.

In the year 2000, a study was undertaken where human subjects were made to consume 450-calorie portions of either soda or jelly beans on a daily basis. Whereas the jelly bean-eating group ate fewer calories to compensate for the fact that they had to eat jelly beans (if only I were a five-year-old when this study started - talk about your dream job!), the soda-drinking group's appetite did not decrease at all - in fact drinking soda may have increased the subjects' appetite (although this increase was not statistically-significant).

The study I mentioned is not alone: research has shown that HFCS may be a serious culprit in the epidemic of obesity since HFCS can be directly converted to fat easily, and a 2006 summary of recent research has shown sugar-sweetened beverages to be dangerous in cross-sectional, prospective and experimental studies.

There is a mountain of scientific evidence that drinking HFCS in soda is bad for you. There's even been talk of putting a Surgeon General's warning on soda cans, since they are so unhealthy. How unhealthy are they? Here's my estimate.

Health Impact of the HFCS in Soda

If you drink that 2L bottle of non-diet soda, you're adding its whole 1000 calories to your diet, since HFCS doesn't fill you up. According to an earlier estimation of mine, eating 800 extra calories has a 94 in a million chance of killing you, which makes the risk associated with consuming a single soda bottle is about 118 in a million: there's a greater than 1 in 10,000 chance that drinking a 2L bottle of non-diet soda will kill you in the following 15 years.

Conclusion

Drinking the soda in a 2L bottle is at least one million times more risky than opening the bottle. Yet, the warning label on the bottle is for the latter, not the former. I wonder if maybe the label is there to try to assure us that the most dangerous part of enjoying the soda is opening it, lulling us into a false sense of security. In any case, once again we see that Americans are concerned with the wrong risks. Let's stop fear-mongering about things which won't hurt us and try to educate ourselves about things that might.

PS I've added drinking 2L of HFCS soda to the ever-expanding risk list wiki. So far, it's the first activity to warrant a yellow alert.

EDIT: I've added the life expectancy decrease (LED) and equivalent driving distance (EDD) metrics to this post. See this post for an introduction to the LED and EDD.

If consuming a 2L bottle of non-diet soda has a 118 in a million chance of killing you within 15 years, then its EDD is (1 billion miles / 14.6 * 118 / 1 million) = over 8,000 miles. So, it's safer to drive for 8000 miles than to consume a 2L bottle of non-diet soda.

The LED is (80 years * 118 / 1 million) = about 3 and a half days: enough to give you pause.

Under Pressure: Attack of the Killer Soda Pop

Greetings, fellow nerds.

If you consume soft drinks in the United States, chances are that you've noticed that this warning has begun to appear on two liter soda bottles. When I first saw it, I could hardly believe my eyes. I find it hard to imagine what possible circumstances could conspire to cause the cap to blow off with enough force to do bodily harm. So why the warning label? Does it really help, or is it just the brainchild of a misdirected torte lawyer?

I'm going to argue that the real dangers of soda come from drinking it, not opening the lid. I'm going to expose how skewed our senses of risk and responsibility are by showing that the high fructose corn syrup in soda does far more damage than its allegedly explosive top. This post will cover the risks of getting blinded by a rocketing soda pop top, while the next one will look into the health consequences of drinking that same soda.

The Letter Never Sent

When I set out to uncover the statistics behind the warning labels on soft drink bottles, I had imagined having to write to a representative of some bottling authority with a request for statistics on eye injury resulting from opening plastic bottles. I'd say my friends and I are casually interested in why these warning labels were deemed necessary, and ask for the reasoning behind the warnings.

I was kind of looking forward to composing the letter. Setting the right tone would be key: I'd have to come across as earnest while acknowledging the whimsical nature of my request. Usually, public relations people at corporations give you the benefit of the doubt and respond in good faith. However, it turns out injury statistics from soda bottles are well-known and published, so writing is unnecessary. I might still write that letter; if you'd like me to carry through with this plan let me know in a comment.

The Answer's Before Our Eyes

I'm not planning on writing the above letter because the British Journal of Optometry has already answered my question. In this publication (.pdf warning), titled “Serious eye injuries caused by bottles containing carbonated drinks”, they say “plastic and metal cans pose little danger: we found no related injury among the 12 889 cases.” Their database held combined data from the US, Hungarian and Mexican eye injuries from 1982 – 2002 (although it didn't have data for all countries and all years).

The paper's authors (F Kuhn, V Mester, R Morris and J Dalma) found not one instance of a soda pop bottle causing an eye injury in any of the countries in any year. It would be a stretch to say that absolutely no eye injuries happened because of pop bottles during the 1982-1999 period in the States (2000-2002 US data not published in Kuhn et al.) since the database of eye injuries used (USEIR) collects information of only serious eye damage, and not all states of the US contribute data to USEIR yet. Still, the fact that Kuhn et al. found not one case of plastic bottles causing eye damage over a 20 year span is suggestive that they're pretty harmless. If you know of someone who has been injured by a plastic bottle top, please leave me a reply about it.

Incidentally, champagne is not so benign. Kuhn. Et al. mention 43 cases of severe eye injury from sparkling wine corks to the face; the majority of these (37) were in Hungary. The remaining 6 wine cork injuries happened to Americans. If we assume the USEIR reflects only about half of all eye injuries, that's still less than 1 serious American injury per year. (Aside: Does anybody know what Hungarians put in their hooch that makes it so explosive? Kuhn et al. are baffled too.)

I'm Armed and Carbonated

Because I'm a physical sciences nerd, I'm going to figure out how dangerous pop bottle caps could be under ideal firing conditions. Typical soft drinks are pressurized to about 300 kPa. If the surface area of the cap is 3 square cm, the cap is under about 90 Newtons of force, or about 20 pounds. If we assume that some manufacturing error resulted in the cap suddenly becoming loose after a vigorous shaking of the soda at room temperature, this 90 Newtons would act on the cap for as long as the cap blocks the exit path of the gas: about 2 cm. If that 90 Newtons accelerates the cap for 2 cm, the energy transferred to the cap would be only 1.8 Joules. Most accidental cap accidents would be under less-than-ideal launch conditions, so I would be surprised if caps blew off with more than 1 Joule of energy.

How much is 1.8 Joules? About the same amount of energy as a snapped rubber band (one with a spring constant of about 250 N/m), if you stretch it three or four inches. That might sting if it hit you in the eye, but it's not likely to do permanent damage even with a direct hit. It probably wouldn't be too hard to get pop bottles approved as projectile toys for kids old enough not to try to swallow the cap.

In summary, my analysis suggests there isn't enough punch in a plastic bottle cap to do serious harm, and the lack of any evidence of eye injuries backs up my case. From here on in, I'm going to assume that the risk of serious injury from pop bottle tops to consumers (forewarned or no) is 0. Of course it isn't exactly 0, but the Kuhn et al. study covered about 5 billion person-years of exposure to pop bottle tops and didn't find a single serious injury, suggesting an upper bound on the injury rate of about 1 per 10 billion: close enough to 0 not to matter.

Time lost to the warning label

Even though an in-depth study failed to find even one instance of a plastic bottle cap damaging anybody's eye, one might think that it's better to abide by the precautionary principal, that is to warn people of the pressure danger in opening their soda on the off chance that we might prevent even one eye injury. I can imagine the person making the decision to put warnings on all plastic bottles would have a warm, fuzzy feeling if they saved the vision of even one child.

I disagree with the precautionary principal for two reasons. First, the cost of having warning labels is not zero: the precious seconds of our lives we waste worrying about inflated risks add up. Second, ubiquitous, petty, self-important warning labels can inure the public to warnings on genuine risks.

Time Lost Reading Gratuitous Fear-Mongering Messages

How many lifetimes have been wasted reading this warning message? Let's assume that, on average, every American reads this warning once per year. (I don't know if the rest of the world has adopted the warning label yet. Let's hope the insanity has been confined to the Home of the Mega Lawsuit.) If it takes about 10 precious seconds of your life to read through the text, that means that nationwide, about 95 years of life are wasted every year we insist of putting these gratuitous warnings on soda bottles. Equivalently, as you read this, you can expect 95 Americans are busy reading through the above text about how their life is potentially threatened by the intense pressure of the liquid refreshment in their hands.

Think of the good which could be done with those 95 person-years. Movies, novels and poetry written, walks in the park, vacations; all of these and more might have been accomplished if it were not for these unnecessary, attention-whoring portents of soda pop doom. There are some who balk at doing moral algebra. I think that 95 years of vision wasted by eye injury is in principal equivalent to 95 years of vision wasted by reading a warning label.

Since the net effect of the warnings is to decrease the visual lifetime of the consumer, I propose that the soda bottle companies stop printing the warnings. I also propose that we allow companies complete immunity from lawsuits arising from activities whose associated risk is so small that to post warning labels does more net harm than good.

Warnings, Warnings Everywhere...

... nor anyone to think. Perhaps the most damaging consequence of posting warnings on soda pop bottles is that we end up reflexively ignoring them. I hesitate to read every warning label I see (in truth, I didn't even notice this one below until this minute when I started looking for warning labels).

What's on the bottom of my keyboard? Is there a risk of electric shock? Perhaps deadly chemicals leak up from between the keys every midnight. How would I know? I plugged in my keyboard, it worked, and I'm happy. There's no way I'm going to pursue every last nagging, ass-covering warning I see out there, and that means I'll ignore warning signs when there are real dangers too.

I think we should standardize a color-coded warning label system, where different risk orders of magnitude have different colors. You could ignore anything less than a yellow then, unless you were exposed to the risk all the time. Manufacturers would be immune to lawsuits over correctly-labeled risks, and would be made liable for time lost if they grossly overstate the risk. I've started a list of color-coded risks - check out my wiki and add to it if you feel so inclined.

Conclusions

Gratuitous warning labels (such as the one on pop bottles) make us worry about the wrong things. There are genuine risks out there, but the system we have for making people aware of them is broken. We need to push through laws that protect companies from one-off lawsuits caused by the failure to alert customers of excessively-small risks, and then maybe we can talk about demanding that risk labels be removed when the opportunity costs or reading them outweigh the benefit they do.

EDIT: I'm adding information of the life expectancy decrease (LED) and equivalent driving distance (EDD) for opening a bottle of soda. See this post for an introduction to the LED and EDD.

If Americans open roughly 100 soda bottles per year, and if the annual risk of getting an eye injury from opening a soda bottle is less than 1 in 10 billion, the risk of opening each bottle is less than 1 in a trillion. That means that even if we were to assume any serious injury from a soda bottle were fatal, you life expectancy would decrease from opening a soda bottle by only 2.5 milliseconds (80 years - a typical lifespan / 1 trillion). Opening a soda bottle therefore has an LED of 2.5 milliseconds or less.

The EDD is computed by the fact that 14.6 driving fatalities occur every billion miles. The distance you'd have to drive to incur the same risk as opening a soda bottle is therefore 1 billion miles / 14.6 / 1 trillion; the EDD is less than 4.5 inches; so driving more than the length of a pickle is more risky than opening a soda bottle, once again with the ridiculous assumption that all bottle top eye injuries would be fatal.

Keeping Bounty Hunters Honest

Greetings, fellow nerds.

Two posts ago I showed how terribly inefficient big pharmaceutical companies are at finding treatments which actually help people. Less than 7% of what you pay for medicine funds useful research and development. In the last post, I outlined an incentive program whereby research companies get compensation proportional to the good they do us, so the incentive is to do work that actually benefits humanity. Today I'm going to show a few refinements to the last post's incentive program which make it more practical.

Refinement #1: What Counts as "Cured?"

Sometimes the success of a treatment can't be reduced to cured/not cured. In these cases, you'd probably replace the "% cured" number in the example I gave (the one which resulted in a $2 billion reward - see last post for details) with a fixed formula, possibly including prevalence of side effects, time for the treatment to work, cost/complexity of the treatment, or other factors. Health organizations get to decide what counts as success, and the researchers who best achieve it get the most award money.

The same disease might even have multiple prizes if desired: one whose formula emphasized quick recovery while the other's formula emphasized the absence of side effects. Complexity isn't necessary, but might be appropriate in some circumstances.

Skepticism Built-in: Incentives for Thorough Studies

It would be a good idea to reward based on the bottom of the 99% confidence interval of the study, so you would have to be statistically sure (at the 99 in 100 level) that the new treatment was better than the old treatment, and claims would tend to be understated. (This is to prevent companies from designing weak studies with few subjects. If you do many of these weak studies, a few of them will, by chance, show the new treatment to be better.) This measure would also provide an incentive for drug companies to do thorough drug evaluation, since the better the study statistics are, the smaller the confidence interval and the more companies get paid. Companies falsifying results would be dealt with just as they are in today's system.

Avoiding Getting Scooped Without Rewarding Pharmasquatting

It's also a good idea to allow a company to be locked in to a certain treatment/disease pair without competition for a limited time: you don't want to have to rush clinical trials to keep the competition from scooping you. I propose that you be able to take out two-year-long exclusive rents for each trial phase of any specific treatment/disease pair combination. For example, a company could pay (say) $100,000 for the exclusive right to do phase II testing of a new treatment. If it looked promising at the end of two years, they would get an exclusive offer to try phase III testing for (say) $500,000 for two years.

The $100,000 and $500,000 figures probably should be linked to the size of the incentive pot to discourage pharmasquatting (the pharmacological equivalent to cybersquatting: essentially leasing large blocks of treatment-malady combinations in the hopes that someone who does real research will buy the exclusive rights off you). If you made the fees big enough that randomly choosing treatment-disease pairs results in an expected loss, nobody will pharmasquat.

Harness Prediction Markets

Once research starts, these leases would have a value which reflects the probability that a certain therapy-illness combination proves fruitful. Allowing these leases to be tradable (and allowing the possibility of dividing them into shares) would instantly generate a prediction market in therapies, harnessing the full power of the free market to finance medical research. It might not be true that the best treatment discovery companies start out with access to the best funding; selling shares in treatment possibilities would be an efficient way of raising capital and of gaging the expected success of new treatments coming through.

Bounties, Ethics and Intellectual Property Law

Right now there's a huge debate over the ethics of withholding life-saving treatments from those who cannot afford the licensing fees. It's a really tough issue: is it OK to demand that people die for the sake of the survival of a company which produces life-saving treatments? If the bounty system were implemented, there'd be no issue over who has to pay what to whom to use life-saving knowledge: as soon as it's discovered, (as long as you are within the group of nations/HMOs that pay their dues - my great hope is that this group would quickly swell to encompass the whole world) you can use the treatment.

Another great advantage to the bounty system is that there would no longer be a need to enforce medical patents. In general, it's a good idea to replace negative reenforcement systems with positive reenforcement proportional to the good done, since it means you don't have to police the whole world.

Conclusions

The bounty system for new treatment discovery gives incentives for medical researchers to find ways to treat illnesses. It can coexist in a world with the current patent-protection paradigm, although if it works half as well as I expect I doubt many people won't join up.

There are probably more refinements to add to the bounty system, and there may be a few flaws in it that I haven't seen. If you think of anything I haven't mentioned (pro, con or refinement) regarding the bounty system, please leave a comment below. Thanks!

A Spoonful of Sugar Helps the Medicine Get Found

Greetings, fellow nerds.

Last post exposed how little incentive there is for drug companies to develop useful new treatments. Only 7% of pharmaceutical revenue goes to finding better drugs. Moreover, this meager 7% isn't normally spent developing any kind of therapy that can't be patented; efforts are skewed towards discovering new and untested substances for the sole reason that they are patentable.

The current system is broken because pharmaceutical companies get rewarded only if the treatments they find lead to widespread purchasing of chemicals they have patented. We need a system whereby private industry gets rewarded every time it discovers a better way to treat pertinent diseases.

Suggestion: Mprize-Like Rewards

The easiest way to reward companies for discovering cures is to do just that: pay drug companies a bounty for each new treatment they show (or discover) that's better than the last one. My favorite way to pay out the bounties would be like they do with the Methuselah Mouse Prize (Mprize for short), similar to the Ansari X prize for commercial spaceflight in that both provide cash rewards for results.

The Mprize encourages scientists to make mice as long-lived as possible, with the hope that some of their techniques could be applied to humans too. Whereas the original X prize offered a single cash reward for the first commercial team to achieve the target (to have one spacecraft fly twice within two weeks to 100 km with a pilot and two passengers or their weight equivalent), the Mprize offers chunks of its money to research teams who provide incremental improvements to the lifespan of mice. Prizes are proportional to how long the winning mouse outlives the old record-holding mouse.

I propose that the financial rewards for research organizations that discover new cures should be awarded incrementally. Like the Mprize, prizes should be proportional to the benefit the new treatment gives above and beyond the current best treatment. For example, say the old treatment for pancreatic cancer has a 25% success rate, the new one has a 40% success rate, and there's $10 billion in the pot for finding a cure to pancreatic cancer. Then, since the company decreased the failure rate (which was 75%) by 15%, they would get (15%/75%) = 20% of the $10 billion, or $2 billion.

Filling the Prize Pots

In a perfect world, we'd solve the prize-funding problem with alphabet soup. The WTO would request a percentage of each nation's GDP to go to the WHO, who would allocate funds as needed. Perhaps nations would get discretion over where 50% of their funds go, so that individual rulers could appease their special interest groups and gain some political capital. (As long as no special interest groups become overwhelmingly powerful in all nations, the WHO could probably end up with the same money distribution they would choose voluntarily by spreading the remaining 50% among neglected but important prizes.)

In an imperfect or intermediate world, only some nations (or a subset of HMOs within a nation) would participate in the bounty system; the others would be required to license any intellectual property discovered by the bounty system. Unfortunately, one of the strengths of the bounty system is that it provides an incentive to discover unpatentable treatments. (I wonder for example how many diseases could be helped by proper exercise. Under the current system that kind of study is hard to fund, so we'll never know.) Groups not participating in the bounty system would thus get these benefits for free (or perhaps at the expense of losing face in the international community for being freeloaders). Researchers outside of the bounty system could choose to claim the cash prize and give up their intellectual property, or they could license their work as they do now.

Still, without the burden of having to market new drugs (recall that only 14% of drug company revenue goes to R & D), it's possible that a bounty-based system could beat drug companies at their own game, producing more patentable treatments per chunk of cash, especially if M.D.s become sick of being hounded by incessant glossy ad campaigns for new drugs of dubious quality. (Hey, I can always dream, can't I?)

Sanity, Meet Drug Quality Regulations

I can't resist adding one more suggestion which would lower the cost of drugs. If you're not squeamish, check out how many rodent hairs and insect parts the FDA allows into food. Here's my question: if it's safe to eat reasonable amounts of contaminants in food (including food we give to sick people), why isn't it OK to allow even minuscule levels of contamination in the medicines we eat? Eating traces of rat hair is either bad (in which case we shouldn't allow it in food), or not a big deal (in which case we should relax the US FDA requirements which keep generic drug manufacturing expensive). Apart from dose and shelf life quality control, generic medicines you eat should have no more regulations than food.

Conclusions

If we want drug companies to work for us, we have to give them incentives to work for us. Right now their incentives are barely aligned at all with discovering new and better medical treatments. By replacing the patent system with a bounty system, we can harness the capitalist desires of pharmaceutical corporations for the benefit of humanity. It will be hard to set up a system which collects money for the rewards, but even if we assume this system is only about 50% efficient and collects 50% of the revenue of today's system, this system would still more than triple the amount of useful treatment research and development going on today. 7% efficiency isn't a hard benchmark to beat.

Let's harness the power of the free market by giving incentives for finding the best (not the most profitable) cures possible.

P.S. There are a few details in the way we'd need to implement bounties to keep people from abusing the system. I'll go into these in my next post. After that, please feel free to point out any remaining flaws in my bounty ideas. Thanks!

Bad Medicine: Big Pharma's Not On Your Side

Greetings, fellow nerds.

Today's medicines fund tomorrow's miracles. That's what GlaxoSmithKline's publicity department decided was the most palatable excuse for the high cost of drugs: we charge a lot to make more magic bullets to fight new and ominous plagues. It's "pay up or die," with a sugar coating.

"Funding miracles" is stretching the truth a bit (as I will show), but I don't fault GlaxoSmithKline or any of the other big pharmaceutical companies. The way we've set up drug research has public and private incentives badly misaligned.

Today I'm going to show the two biggest ways in which our interests are misaligned, and in the next post I'm going to suggest a fix which will provide an incentive for drug companies to do the most good possible for humanity while still making boatloads of cash.

First Flaw: Drug Companies are Promotion Companies

The overwhelming majority of drug company revenue goes to drug promotion, not drug discovery. Let's take a look at the raw data on drug company revenue and research and development (R & D) expenses in 2004. (From MedAdNews, September 2005. Wikipedia link here for those without a subscription.)

Rank	Company	Revenues (USD billions)	R&D Spending (USD billions)
1	Pfizer	50.516	7.614
2	Johnson & Johnson	47.348	5.203
3	GlaxoSmithKline	37.318	5.204
4	Sanofi-Aventis	31.615	4.927
5	Novartis	28.247	4.207
6	Hoffmann-La Roche	25.163	4.098
7	Merck	22.939	4.010
8	AstraZeneca	21.427	3.803
9	Abbott Laboratories	19.680	1.697
10	Bristol-Myers Squibb	19.380	2.500
	Total	303.63	43.26

Less than $1 for every $7 of drug company revenue is spent on finding new drugs. Now, I have nothing against a company making a tidy sum of money off of its investments, especially when some degree of risk is involved. However, > 600% return on investment is excessive, and indicative of a serious failure of the free market, which is supposed to deliver goods with minimal overhead.

I lied: that $6 isn't all investor profit. In fact, the majority of it goes to promotion: direct promotion to doctors, HMOs and even patients themselves. Here's a more honest slogan for GlaxoSmithKline: "Today's ad campaigns fund tomorrow's ad campaigns."

Second Flaw: Half of R & D has Minimal Benefit

Of the sliver of funding which goes to drug discovery, about half of it goes towards providing novel (and thus patentable) but not superior medicines for diseases we can already treat. Here's a link to a review of "The $800 Million Pill" (which quantifies the money wasted on redundant drugs) by BusinessWeek. I'm linking to this review because it defends the actions of drug companies within the system (as do I) without asking how we could make the system give better incentives for companies to do good for humanity (which is the whole point of my 21st century capitalism idea).

Essentially, since companies can only make money off patented drugs and since patents typically last only about 20 years, there's a huge incentive to discover new cures to already-controllable diseases. The new cures don't even have to be superior: marketing departments of big pharmaceutical corporations have enough muscle to push new drugs into the marketplace regardless of whether or not they're needed.

Drug Discovery: 7% Efficient?

In total, only about 7% of the money paid for drugs goes to finding new useful medicines. It's a tautology then that any solution resulting in as much (or more) useful R & D funding while lowering the cost of drugs would be a good thing for humanity. If you're tempted to counter that it's a good idea to maintain non-productive sectors of the economy (like the $282 billion per year drug companies spend on things other than useful R & D) to create jobs, you should familiarize yourself with the parable of the broken window. In any case, I'm going to introduce a system which beats today's 7%-efficient system in my next post.

In truth, 7% might even be an overestimate of the efficiency with which our drug expenses fund cures. Recently, a group of scientists from the University of Alberta discovered that a small and un-patentable molecule (dichloroacetate, DCA) might cure most cancers with little side effects. (At excessive doses, DCA can cause trouble, but then again, so can water - see line 202.) Whether or not DCA will turn out to be one of "tomorrow's miracles," it's unsettling that the major drug companies have avoided studying it like the plague due to an absence of profit motive. It underscores the fact that drug company revenue really doesn't work in the public's best interest. It's time to align our interests more strongly - I'll suggest one way to accomplish this in the next post.

Conclusions

Eighty-six percent of the cash you pay for your meds funds mostly advertising, not R & D. Half of the remaining 14% goes to try to produce new medicines which aren't better than old ones - they're just patentable. The remaining 7% of drug company revenue is devoted to new cures, but only those new cures which might result in a patentable drug: any promising treatment which isn't patentable will be suppressed.

You're getting a raw deal. Let's change the incentive system for big pharma so that they want to be on our side.

TO BE CONTINUED...

PS If you agree with me, let's try to generate a buzz. Forward a link of this to your friends. If you disagree with my facts or my reasoning, please post your findings as comments.

Fill 'er Up with Air: the 25¢/Gallon Asthma Tax

Greetings, fellow nerds.

Today I'm going to quantify the asthma cost of burning one gallon of gas in the US. Car-derived air pollution is a major contributor to asthma in the United States. Human suffering aside, let's estimate the cost of providing asthma care associated with burning 1 gallon of gas, and figure out who should bear that cost.

Economic Burden of Asthma

A 2003 study estimates the per-capita cost of asthma to be $4,912, and in 2004 there were 17,624,930 Americans with asthma. The total cost of asthma to the US is therefore about $87 billion, although it's likely to have increased since 2004. To put that in perspective, the US trade deficit for 2004 was $611 billion, less than 7 times the cost of asthma.

In 2004, the US burned 20 million barrels of oil per day, which works out to 318 billion gallons for the year. If we were to attribute all the asthma in 2004 to vehicle-caused air pollution, the asthma cost per gallon of gas burned would be just over 27¢. The 2007 costs of asthma must be greater than 2004's 27¢ per gallon, but on the other hand not 100% of asthma is caused by air pollution. (However, asthma rates have quadrupled in the last few decades according to the WHO, suggesting that human-made factors like air pollution play an overwhelming, if not exclusive, role.) In any case, for every gallon of gas you burn, you do approximately a quarter's worth of damage through asthma.

Benefits of the Asthma Tax

Let's add an asthma tax to gas and make it pay for everyone's asthma treatment. It wouldn't be prohibitively expensive; I bet the per-capita cost of asthma would also go down if treatment were universally free, since the cost of treating acute attacks of people who rush into emergency rooms must be a lot higher than the cost of preventative care. This cost-reduction from efficient treatment would mean the average American would pay less total in health insurance premiums and gas combined. Those without insurance would also suffer less, let's not forget. It would be only those whose lifestyle currently creates disproportionally-large asthma suffering who would suffer under the asthma tax.

The Asthma Tax and 21st Century Capitalism

As long as the asthma tax were related to the true cost of asthma care, auto manufacturers would have a financial incentive to keeping the skies clean: they believe they can sell more cars with the price of gas low, and a low incidence of asthma would lower the at-the-pump price. The public and private incentives would be aligned, which is what 21st century capitalism is all about: getting people working together.

Let's not forget the human element of 21st century capitalism. A disproportionate number of poor urbanites suffer from asthma. Imagine the effect of the goodwill they would feel if the rich showed a little compassion by at least paying for the medical treatment of the damage they've done with their smog. If you actively oppose a measure which lowers costs and brings goodwill to humanity, you're a troll.

Conclusion: Let's Do It

In conclusion, the quarter-a-gallon gas tax would relieve human suffering, decrease the financial burden of treating asthma, and provide a direct incentive to auto manufacturers to start taking better care of us. It's a win-win situation; let's get started.

Mad about BSE

Greetings, fellow nerds.

This will be just a quick post about the relative risks between the "mad" and the "cow" in mad cow disease. In truth, the danger "tainted beef" poses to us is so small that as a consumer, you should forget about mad cow disease entirely: it's a waste of neurons. I'd even feel guilty making you read this post if it weren't for the fact that it exposes the sensationalism behind mad cow disease reporting.

Assessing Mad Cow Lethality

Mad cow disease in cows is called bovine spongiform encephalopathy (BSE), and to date there have been at least 188515 reported cases of it worldwide. Common sense suggests that there are a whole lot of unreported cases too, considering the incentives farmers have to keep things quiet. The disease humans contract by eating infected cows is called variant Creutzfeldt-Jakob disease (vCJD), and there have been a total of 170 confirmed cases worldwide. This number is probably not exaggerated (in fact the false positive rate for vCJD might be rather high), so you might think of 170/188515 (or about 900 per million) as an upper bound on the chances of contracting vCJD from eating an entire mad cow. However, probably not all of the 188515 cows were consumed in their entirety, which means that 900 per million might be a good ballpark figure as to the actual transmission rate from eating a whole cow.

If there are roughly 250 lbs of meat per cow, and if a typical beef meal has a quarter pound of meat, the odds of catching vCJD from a single meal of infected beef are 900 in a billion. When you consider that in the time period the 188515 cows were detected, the UK (the country hardest-hit by BSE) produced about 100 million cows, the risk of getting vCJD from eating one randomly-chosen UK beef meal is about 2 in a billion.

No Consensus among Academics

Why aren't I just reporting what the medical journals say about BSE to vCJD transmission rates? Because these estimates are all over the place. This study in the journal "Risk Analysis" by Eric Grist shows that there's nothing like consensus regarding the risk of a human contracting vCJD from eating an infected meal: published transmission rates vary from 0.9 in a billion to 7 in a thousand (c.f. my estimate of 900 per billion based on case numbers). The "Risk Analysis" article continues on to point out that the 7 in a thousand measure is obviously inconsistent with observed vCJD infection rates. (Thank you, Dr. Grist!) Perhaps even researchers are prone to sensationalism, especially if the said sensationalism might result in extra funding.

New Risk Metrics

We need better units for analyzing risks. It's hard to grok these raw numbers without an everyday context, so I'm going to introduce two new metrics:

1. Life Expectancy Decrease (LED)
   
2. Equivalent Driving Distance (EDD)
   

The LED measures the expectation of the decrease in life expectancy based on taking the risk once, assuming an 80 year lifespan. So for example, the LED from eating a meal with UK beef at the height of the mad cow scare is (80 years * 2 per billion) = 5 seconds. Compare that to the LED associated with the extra calories in your fast food meal: (80 years * 94 per million) = 2.7 days. The extra risk of vCJD is insignificant next to the threat of the extra calories involved with taking a big bite of beef.

Driving cars is a risky activity that most of us have come to terms with. Driving therefore provides an ideal reality check that helps us put new risks in perspective. This DOT report (page 8 of the .pdf) shows that there are about 14.6 vehicular fatalities for every billion miles traveled. The EDD of a new risk is the length of the car trip with the equivalent level of risk. For example, the EDD of the untested UK beef meal is (2 per billion * 1 billion miles / 14.6) = 720 feet; less than one Manhattan city block. Again, if the beef was in a fast food meal, the EDD from the extra calories is over 6400 miles: greater than the radius of the Earth.

Conclusion: Calories Matter More than Prions

If you spent more than 5 seconds worrying about contracting vCJD from beef, even at the height of the mad cow scare in the UK, you've been had. Also, if you think a fast food meal saves time, you should consider the 2.7-day lifespan decrease it brings (unless you're underweight - see my blog entry). It's true that the risk was unknown at the time (so maybe caution was indicated), but I'm getting sick of people worrying about false alarms, especially when there are more pressing issues which aren't getting enough attention.

I'm also disillusioned with the media, although I can see their point. Nobody will buy a paper saying "Get Off Your Butt and Get Healthy," but "New Plague Risk Sweeps the Nation: Will YOU Die?" has more zing.

As new crises come up in the news, I'm going to try to keep up with the LED and EDD metrics for them. With any luck, they'll catch on as popular reality checks for how risky a new terror actually is.