28 February 2012

Direct to consumer marketing of prescription drugs

I’m taking this class on drug and device law, where we get to say things like “MDUFA” (pronounced ‘mah-doo-fah’) and “PDUFA” (pronounced ‘pee-dee-ewe-eff-ay’ – haha, jk, it rhymes with “Paducah,” or “Palooka”) and where we have phrases like “adequate directions for intended use” and “intent to introduce into interstate commerce misbranded or adulterated drugs” drilled into our heads.

 

One of the questions the profs keep trying to engage the class on is, if you were designing a legal and regulatory scheme from the ground up, would you still have the most salient features of our system – premarket approval of new drugs, for example? Would you still have the same standard for labeling (indication) claims, and how would you handle off-label use of drugs or devices? All of which is interesting, and really, for people who are my age and who have spent a good chunk of their adult life in a world where prescription drug manufacturers spend eight or nine billion dollars annually on advertising, it’s hard to think back to what life must have been like before the restrictions of direct-to-consumer (DTC) marketing of prescription drugs.

 

When asked point blank whether this was a good thing or not, I said I supposed so, since I wouldn’t have known about “restless leg syndrome” without it, and the follow-up question – “is that a good thing or a bad thing?” - took me a little by surprise. Most people in the class reasoned that ultimately it’s not bad to inform patients of treatment options and of drugs that might help them with their treatments and that on the balance, the good outweighed the bad – not to mention that the historical proscription against DTC promotion might not survive a first amendment challenge today. But I kept coming back to the idea – the question, really – of why, if we all agree that the social or public utility here is about information, does Cymbalta have a theme? (It gets stuck in my head for days at a time.) Why are so many of the commercials designed to include emotional cues? Those commercials may ostensibly be about informing, but they’re also about creating an emotional connection with the viewer and are largely designed to titillate the senses, if you will. I know this is a fairly obvious point I’m making here, but wouldn’t the obvious conclusion, when watching these commercials, be that their intent is to sell a product rather than to inform?

 

None of the smartypants law students had an answer for me on that score. So I’m congratulating myself for judo-chopping your Socratic methodology, Georgetown Law Center. So. Crates.  

 

 

 

21 February 2012

Mike Mills

 

I knew him in high school. We weren’t particularly close – more like our social networks intersected in a couple of salient areas, but that was about it. He was nice – a bowler hat, that 90s thrift look, and a very reclusive demeanor. I probably don’t think of him very often, not consciously, but unconsciously, I always remember him when I change lanes while going through an intersection.

 

Memory is arbitrary. I can’t help that the smell of flowers puts me at a street corner in Bethesda, or that the very idea of coffee and cigarettes translates into a chilly morning in a dorm in Ohio. I was giving Mike a ride somewhere in Rockville – back on Parklawn or something, near a Sear’s store, I think. As I changed lanes while going through an intersection, Mike said to me, “Did you know that’s illegal?”

 

“What is?”

 

“Changing lanes while going through an intersection. I got pulled over doing it. It was a 25 dollar ticket.”

 

“Really? I had no idea.”

 

“I guess you’re just luckier.”

 

There was something about the way he said it, and this isn’t just some cheesy bit of misremembering or romanticizing the past. The “something” about the way he said it didn’t tell me that I’d be writing this today, after his death. The “something” was a quality of being put-upon, down-and-out, perpetually unlucky, and also a profound indifference to the condition of being put-upon, down-and-out, perpetually unlucky. Maybe there was anger there, too. Probably there was. The reason political correctness seems like such a 1990s phenomenon is partly because the 1990s were closer to the 1980s than to the 2000s. It’s entirely more likely that Mike Mills may have been targeted by the police, by chauvinists or the intolerant, because he dressed a little bit weird for the suburbs. So did we all, but Mike still kind of stood out.

 

Sometimes shy people are just boring, as Jens Lekman says, but I never found Mike to be particularly shy and he was definitely not boring. He was a good person, gentle and kind. I hope he went on to be less put-upon. He didn’t have a whole lot of time, but considering he was probably 16 or 17 when I knew him…well, he only had another 16 or 17 years for the world to make it up to him. I hope it did, or that it at least came close to making it up to him.

 

   

17 February 2012

Things about grad school.

 

After this, I want to never ever use the term “exogenous” again.

 

Also, fuck regressions.

 

I’m pretty sure GPPI is the reason I’ve been reading more fantasy the past few years. I miss serious fiction. “The Year We Left Home” – I haven’t forgotten about you, I promise.

 

What if the whole program was just an expensive way to get invited to a Kathleen Sebelius speech? It may still have been worth it.

 

I think I miss going to shows the most. May cannot come soon enough.

13 February 2012

Ok, that was probably wrong.

I probably went a little too far in suggesting some racial animus for the Whitney pushback. I mean, that exists, but I’ll settle for some kind of weird cultural bias.

 

 

Coverage of a dead black female entertainer? OVER THE LINE!


So, I’ve now seen two different things on Facebook that are a variation of, “Yes, Whitney Houston died yesterday – but these soldiers are dying every day! Where is the news coverage for them? Let’s remember the true heroes!”

Which, I mean, for fuck’s sake. Let’s think this through: the media constantly cover stupid stories. My first thought is, why aren’t you outraged when the media is covering tiger moms or Kate Upton or Giselle Bundchen criticizing Wes Welker? Is two days of coverage of the death of a black woman who was the most powerful entertainer on the planet for a few years really over the line?  In other words, the media were doing everything right until this, but it’s in the coverage of Whitney Houston that we see that the media have truly lost their way?

Secondly, as noted above, this person was fairly important. And she died the day before the most important pop music awards ceremony. Isn’t some media saturation to be expected?

THIRDLY! (I have a thirdly!) Remember how conservatives reacted when the media DID offer daily casualty totals? Didn’t conservatives criticize the media for focusing on body counts instead of progress? And let’s say the media switched immediately and started to offer detailed coverage of soldiers who died, what would we see? There'd be a campaign like, "This soldier died - RIP. BUT WHAT ABOUT THE VICTIMS OF OBESITY? WHO WILL SPEAK FOR THEM?" Or whatever. There's always someone else dying somewhere, and there's always someone complaining about the coverage being of the wrong dead person. 

So, this didn’t quite come out wrong, but in terms of inconsistent/bizarre conservative memes-du-jour, this someone seems to be up there.  

10 February 2012

Does this make me a kiss-ass?

During my travels with my CEO last November, I discovered that she has awesome taste in music. She likes more adventurous stuff than most people I know – for example, she loves loves loves Animal Collective, who I really like too but who I basically wouldn’t recommend to anyone, even people I know who have fairly complex musical tastes. She also really likes Bon Iver, who are definitely a more accessible group but still sort on the periphery of being mainstream. Anyway, I was all excited and asking her if she knew this that or the other, and she didn’t, so I was like, “That’s it – I’m making you a mix cd.” And I finally did. Does that make me a kiss-ass? Making a mix for your CEO? My position is that it would be a kiss-assy thing to do if Karen were like, “Oh, I’m really into polka,” and I ran off and did all this research to pretend I was into polka, and then made her a mix cd of stuff I didn’t really like. (Though in fact, I should hasten to point out that I don’t dislike polka, but my polka collection isn’t really deep. It basically consists of this album, and a couple of isolated tunes like the Bluegrass Sessions band doing “Polka on the banjo,” or Faith No More’s cover of “Das Shutzenfest.”

 

So, for now, I’m going with “I am not a kiss-ass.” Feel free to disagree.

 

Did you know that today, the greatest Internet thing ever took place? It’s true. Behold, the health policy valentine’s hashtag.

 

Speaking of health policy, I am at a loss to explain why patients in states enacting tort reform are sicker, across the board, in the post-tort year. Granted, I’m looking at hospitalizations, so I can conjecture that possibly there is some work on the front-end, on the intake side, that is being postponed till patients get sicker (which would support what proponents of torts say) but that this in fact creates an unexpected high demand on hospital services on the backend (since total charges are up across the board for post-tort years.) But my advisor is hardly sold, and he’s right, since I can’t really show that there’s any causality there.

 

This weekend, I have one very exciting thing to do: making 1554 ice cream. Other than that, I will be reading about the Abigail Alliance’s doomed quest to either increase last-resort access to experimental drugs by terminal patients or to undermine the whole structure randomized controlled clinical trials, depending on whose opinion you take a shine to, and struggling with nearest-neighbor-matching techniques. You know you are wishing you were me. But I mean the opposite of what I just said, so like Elaine’s version of bizarro Superman, I should live underwater, be black, and say “badbye” instead of “goodbye.”

 

03 February 2012

"Wanna shoot some hoops?"

 

I keep having this image of my sister, in front of my parents’ house. It comes back vividly, now that they are packing up the house to move back to Rio for a few years. I am home from college, maybe? And she is there in the driveway, under the basket, ball in hand, asking if I’d like to shoot some hoops. I probably made fun of her for using the phrase “shoot some hoops” because I’m such a dick and I was a terrible older brother.

 

Yeah, I’d like to shoot some hoops now. I’d really love to. Next time we hang out, maybe?

02 February 2012

Mordred by John Ashbery | The New York Review of Books

This poem used to be on my fridge. Not because it has any relationship to food, per se. But it's a damn fine poem.

Mordred by John Ashbery | The New York Review of Books

01 February 2012

Evidence of my lack of intelligence

Neighbor: So, I’m really worried about our president.

 

Me: Oh, I missed the condo association meeting. Is he ok? He’s not hurt, is he?

 

Neighbor: Yeah, he’s fine, it’s just that he might not win.

 

Me: Someone else ran for board president? How is the vote count taking so long?

 

Neighbor: No, not Matt. Obama.

 

Me: Oh. I’m not worried about him at all.

 

[Enter Matt]

 

Me: Hey Matt. Glad you’re not hurt and that no one is running against you.

 

Matt: What’s this now?

Records you should be listening to right now

The Cloud Nothings, The Water, Imperial Teen, Kathleen Edwards. Oh, and Das Binky.