Tuesday: Reality Check

So, does anyone believe that the red beanie boys lost their case against no-cost contraceptives in the health insurance plan because Barack Obama has a deep commitment to women’s reproductive freedom or equality?

Or does he have a problem with women and he needs to throw them *just* enough of a bone to win their votes but not enough to piss off the religious too much?

It’s the latter.

While the percentage of Democrats who describe themselves as liberal has also increased since 2000, rising ten points, the Democratic Party remains much more ideologically diverse than the G.O.P. Roughly forty per cent of Democrats call themselves “liberal,” forty per cent call themselves “moderate,” and twenty per cent call themselves “conservative.”

“Such numbers explain why liberals seem destined to perpetual disappointment in Democratic presidents, who cannot lean too far left without alienating the party’s moderate-to-conservative majority,” Will Marshall of the Progressive Policy Institute argues in a recent report.

So, if moderates are still crucial to Obama’s election, what do they look like? Over at Third Way, Michelle Diggles and Lanae Erickson take a deep dive into the data to show that the real swing vote for Obama is a group they call Obama Independents—voters who “liked and voted for [Obama] just 3 years ago… were the most ideologically moderate segment of the electorate,” and “are true swing voters, with one-quarter voting Republican in 2010 and one-quarter voting for President Bush in 2004.” This group, which we are likely to hear a lot about in the coming months, is disproportionately young, female, and secular, and it was hit hard by the recession. One quarter of its members are non-white.

If Obama goes, so does the free Lo-Ovral.

This is the problem with politicians who do not have a coherent worldview, and Obama never has had one.  He has not made any effort to craft policy that will advance women’s equality in the workplace or the doctor’s office.  It’s not one of his goals.  Failure to plan on your part does not constitute an emergency on his.  The problem with Democrats is not that their factions are all over the place.  The problem is that they try to cater to these factions without providing a coherent vision for the future.  There is nothing that sticks Democrats together under one united idea of how the country and world should work.  So, Obama careens from one interest group to another trying to thread the needle between pissing off the religious nutcases, who do have a particular worldview, whether we like it or not, and the rest of us.  Plan B is a contraceptive too far.  Women should get a majority vote from their family and pastors before an abortion.  But contraceptives are probably ok, according to the data mining algorithm.

He’s done the same on the banker/financial sector fiasco.  Instead of developing policy and solutions based on an understanding of what is wrong with the economy and having a vision of how it should work, he has taken an ad hoc approach and tries to cut deals with each player individually.  That is more of the Teddy Roosevelt model but it leaves us open to more misbehavior by the banks because there still aren’t any rules to keep them from gambling our money away and then expecting the government to bail them out.  He should have started with the premise that it is wrong to compensate gamblers for their losses and then figure out how to prevent that from happening again.

Well, you know the rest.  Obama is pandering here to his swing voters, who happen to be moderate, secular women of childbearing age, in order to get votes.  He’s going to save them a bunch of money between now and November.  But that won’t get them better jobs or jobs at all.  It won’t prevent Walmart from subtle sexism that prevents women from getting ahead.  It won’t make measurements of workplace parameters to prevent “he said/she said” accusations about discrimination that no one will take seriously.  He’s not interested in equality.  He’s interested in getting re-elected.

No, Obama’s decision to cover contraceptives is a one time only deal.  There’s no systemic change to the culture.  He is not an agent of change.  He is an agent of Obama and women are the worse for it.

Psych! Prions and Ice Nine

3D structure of amyloid fibrils

I saw this post about the possibility that Alzheimer’s is an infectious disease at Derek Lowe’s blog, In the Pipeline.  There’s a new paper out that reports that animals whose brains were exposed to misfolded amyloid-β protein extracted from patients with Alzheimer’s disease will go on to also develop amyloid plaques while control animals do not.  While there is a reputed genetic component to the development of Alzheimer’s disease, this study suggests that it can be induced by the transmission of a prion from one animal to another.  Prions are infectious bits of protein.  They’re teensier than viruses even.  In the case of amyloid disease, the protein under investigation is about 42 amino acids long, which is tiny.

The principle is this: in order to function properly, proteins need to fold into distinct secondary patterns and then a specific 3D shape.  If the protein is misfolded, it doesn’t work properly or it can aggregate, ie form clumps.  The sneaky think about prions is that they can induce other proteins to misfold.  The misfolded protein is in a lower energy state than the properly folded state so the protein can’t unfold itself and refold properly.  It’s stuck.

If any of you have read Kurt Vonnegut’s novel, Cat’s Cradle, and can remember anything beyond spritual footrubs and Bokononism, you may recall that one of the characters created a substance called Ice-9.  A single crystal of Ice-9 had the potential to freeze all contiguous bodies of water.  Throw it into a bathtub, the bath water freezes.  Throw it into an ocean, the ocean freezes.  I can’t recall if it stayed that way permanently but after Ice-9 was released, the world started to die of thirst.

The introduction of amyloid-β prions into a healthy brain may be doing an analogous thing by inducing newly formed amyloid protein to misfold.  And an excess of misfolded protein tends to aggregate, triggering inflammation and, down the road, dementia.  Mad cow disease is also a prion disease that in sheep manifests itself as scrapies.

Er, no one knows how to fix it yet.  One of the problems with developing a drug for Alzheimer’s disease is that the enzyme that normally would be targeted for inhibition, γ-secretase, is also used to cleave a protein called Notch, which the cell can’t really do without.  So, there’s that.  Drug discovery is much harder than it sounds, as Derek says in this recent podcast that he did with Paul Howard from the Manhattan Institute.

The frustrations of the drug discovery process that Derek describes reminds me of the central tenet of Bokononism:

“Beware of the man who works hard to learn something, learns it, and finds himself no wiser than before. He is full of murderous resentment of people who are ignorant without having come by their ignorance the hard way.“

Well, we *are* learning but the truth comes slowly and the answers to the questions are frequently accompanied by a whole new set of questions that must be answered.  This is in part why the pressures of the financial industry have been particularly harmful to the pharmaceutical industry and may have contributed to the high price of drugs.  Drug discovery is a long term process.  It can’t be sped up just to meet the numbers on a spreadsheet for the bean counters.  Cost controls that are intended to whip researchers to pick up the pace are bloody useless and counterproductive when applied to the complexity of the cell, something that the guys with executive hair may just now be realizing.  There’s not a whole lot more of mergering, cutting and restructuring that can be done at this point.  And the patent cliff still looms.  It’s going to be a rough ride for the drug industry for the next couple of years.

Derek also points out that the drugs that are now being approved were probably first discovered or synthesized in the mid 1990’s.  That means the patent clock has been running down for some of them and if there’s not a lot of time left to recoup the costs of discovery, it gets passed on to the consumer as higher prices.  There are other contributing factors to the cost of drugs but the length of the process is a significant one.

I encourage readers to check out the podcast.  Derek also discusses a new therapy for cancer that involves harnessing the immune system.  Fascinating and promising.

The Ring of Gyges (It’s a post election blog)

Note: This is a post election blog but it has a slow buildup.  It will all make sense by the last paragraph.

Last week, Glaxo Smith Kline (GSK) was fined $750 million for failing to clean up a production facility in Puerto Rico.  Here’s a quick summary of how the case went: The plant in PR produces Cidra among other products.  It was cited by the FDA for violations of good manufacturing processes.  The FDA told the plant to clean it up.  GSK sent a woman named Cheryl Eckard, a quality assurance manager, to PR to look into it.  Eckard reported back that the plant was in worse shape than previously thought.  And GSK ignored her.  Repeatedly.  GSK did not address the issues of the PR facility.  I guess what the FDA doesn’t know won’t hurt them.  Eckard got to be a pain in the ass, so GSK fired her.  That’s when Eckard decided to blow the whistle.  As part of the settlement with the government, GSK has to fork over $96 million to Eckard for damages.  She’ll never get another job.

Derek Lowe, who writes the excellent pharmageek blog In the Pipeline has this to say about the suit:

I’ve written about this sort of thing before, and I continue to think that this is a good law. It takes a tremendous amount of nerve to put your own livelihood at stake to report something that’s going wrong (and isn’t being fixed). The incentives need to be there. If we were a perfectly altruistic species, any of us would have no problem sacrificing ourselves immediately for the good of the whole. But the very fact that there’s such bad conduct to take the risk of reporting on tells you that we’re not that sort of species at all.

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I’m not enough of a libertarian to think that the market will take care of all such behavior without an extra possibility of punishment backing it up. I think that we really do need regulatory authorities (although we can argue the details after that statement!), in the same way that we really do need police forces. Both of those groups can (and do) abuse their authority at times, but both of them also provide a much-needed function, human nature being what it is.

And the nature of big organizations being what it is, too. “Never explain by malice what can be explained by stupidity” is a pretty good rule, and in a large company, you can add inertia, backside-covering, careerism, and deciding that a given mess is someone else’s problem. The bigger a company, the more chances there are for these things to happen. Perhaps the possibility of a $750 million dollar fine will help to concentrate attention in such cases – and if not, well, how about a billion? Try for two?

The FDA busts production facilities all of the time but most companies suck it up and fix the problem or shut the facility down, as happened with the makers of the Today Sponge.  Remember Seinfeld’s Elaine Benis who picked her lovers based on whether they were Spongeworthy?  The company that made the sponge couldn’t get rid of bacteria in the manufacturing step and they couldn’t identify and fix the problem so no more sponges.  That’s the way it should work.

So, we see that regulation of what goes into our bodies is working.  And no one would argue that that is a bad thing.

But when it comes to the financial industry that handles our money, it’s a fricking free for all.  What we have is like a never ending season of Deadwood.  There’s very little regulation, no one agency that’s minding the store, financial entities who choose their own regulators, trillions of dollars gambled away, young hotshot assholes who think they are smarter than the rest of us and deserve whopping bonuses, and companies who should be paying massive fines for fraud instead receiving billions of dollars in taxpayer bailout money instead of being shut down for failing to clean up their act.

No one is accountable for any of their actions in the financial industry.  They get away with anything and everything.  Their actions have brought the world economy to the brink of catastrophe and we were spared that by a hasty and ill structured financial bailout package that hasn’t fixed anything.  Not only have the financials learned nothing, but they turn out to be the biggest terrorists we face.  All they have to do is threaten to send the stock market plunging and presidents and legislatures give in to their demands for more chips to gamble on the world economy.

The result of letting the financials off the hook is misery for millions of workers from Ireland and Iceland to America and Greece.  It is simply inexcusable for these people to continue to operate unchecked.

So, before Speaker Boehner decides to slash taxes for many of his buddies with a cent or two for the rest of us and before he decides to make it almost impossible for me and my buddies to retire, the very first thing I expect him to do is hold the financials accountable. The people have spoken.  They want change.  But if we want real change, we can’t put the cart before the horse.  No one should get a tax break while the fox is still guarding the hen house.  I want to see takeovers of failing banks by the FDIC, no matter how big they are.  I want to see banks fined heavily for fraudulent foreclosures.  I want to see a real mortgage program so that people can stay in their houses and pay a reasonable amount to the investors who stupidly got themselves and us into this mess.

No presents until someone pays for the party. Don’t look to taxpayers to pick up the tab or sacrifice even one more cent.

That is what I want Speaker Boehner to concentrate all of his efforts on in the next two years.  Everything else is superfluous.  He’s got a lot on his plate holding the people who got us into this mess responsible for their actions and accountable for the high deficit spending that was necessary to keep us from teetering on the edge of insolvency.  There is no greater responsibility he has to the rest of us than making the financial industry solvent again without any additional sacrifice from us and I expect him to take this job seriously this time and forego stupid Republican slogans and grandstanding.  The last thing I want to see is Speaker Boehner blaming the victims, ordinary American citizens, for this catastrophe.

Human nature has not changed in the more than two thousand years since Plato wrote his story about The Ring of Gyges.  The magical ring was found in a cave by a poor shepherd.  The ring gives its wearer the ability to become invisible.  With that invisibility, the shepherd was able to sneak into the palace, seduce the king’s wife, kill the king and take over the kingdom and all of its riches.  The moral of the story is that morals themselves are not innate.  Society has a role in correcting misbehavior.  If a person can operate invisibly, they can get away with murder.  We shouldn’t assume that anyone can resist the temptation to take advantage of an opportunity if they think they won’t be held accountable.

Speaker Boehner now has the opportunity to shed his partisan skin and show the rest of us that he means to make people accountable.  Or he will be the first one tossed out in 2012.

The Republicans have now been warned.  If they don’t make bankers and the financial industry accountable, they will be held accountable instead.

Austerity without accountability will get you fired.  We’re holding Republicans accountable now.  Don’t test us.