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Posted by Derek
What's going on over at Slate, anyway? So far this week we've been talking about that Timothy Noah article over there publicizing the bizarre Light and Warburton estimate for drug development. Now one of their house blogs erupts with a geyser of idiocy about the looming patent cliff in the industry:
So this sudden terrible problem has been obvious and on schedule for at least 10 years.
It honestly is that simple and that stupid. The pharmaceutical industry turned all its energy toward wringing as much money as possible out of the drugs it already had, and quit making any sort of plans that would lead to having a new (and, you know: medically useful) batch of drugs under patent in the future, when the patents on the old batch expired.
Now the pharmaceutical companies are laying off tens of thousands of workers because they are worried about their financial future, because although they are officially in the business of producing and selling drugs, they stopped producing drugs.
It goes on in that vein; in fact, it gets even more stupid. And the point isn't that someone wrote something like this, so much as that this reflects, I fear, what a lot of other people think. Writing this blog has exposed me to a lot of smart, interesting people, which is something I really enjoy. But it's also exposed me to a lot of troglodytes who have no idea of what they're talking about. And here we have another one. Unfortunately, if enough people believe something idiotic, those beliefs can have consequences.
Now, we can argue about pharma strategy, which we do all the time around here. Where to spend the time and money, which programs to push and which to walk away from - everyone's got their own opinions. But if the line you're pushing is that drug companies just haven't been doing any research at all for the last ten or twenty years. . .well, then you're a moron. On the evidence of this column, Slate's Tom Scocca is one, at best, and his piece is a waste of electrons.
For one thing, there actually have been a few drugs introduced over the last ten years or so. Not as many as we'd like, or as many as we were planning on, but still. And then there are the failures. I mean, I say a lot of nasty things about Pfizer here, for example, but we can list off the big drug projects that they've had die on them over the last few years. Same for Merck, for Novartis, for BMS and AZ and for everyone else.
Honestly, I really think that we should make a bigger deal out of clinical failures in this industry, so that people realize that (1) we're always trying to do something, (2) it doesn't always work, and (3) it costs a godawful amount of money. As it is now, no one outside of the industry really notices or remembers when the giant multi-year research programs go down in expensive flames. And that leaves the door open for knuckle-dragging stuff as quoted above, and for the fools who believe it.
Comments (70)
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1. BariTony on March 9, 2011 9:34 AM writes...
Honestly, I don't know how you put up with it all. I've gotten so tired of this sort of thing I don't even bother arguing with people anymore.
I have noticed one curious dichotomy, though. I've met people who bash the heck out of the 'evil pharma companies', but when they ask what I do and I politely tell them that I'm a researcher in the pharma industry, they're actually quite nice to me and full of questions about what I do and seem genuinly interested. Maybe it's human nature, but these sorts of troglogytes seem to despise particular groups of people, while at the same time being able to like the individuals who are part of that group.
2. exMRK on March 9, 2011 9:37 AM writes...
While that might be overstated, I don't think, for example, that MRL's denying scientist access to SciFinder and other discovery computing tools to save a few $million per annum fits into the general picture of being a "research driven" company.
3. Rick on March 9, 2011 9:44 AM writes...
I posted this elsewhere on the ITP blog, but I thought it was so darned brilliant ;-) that I'd re-post it here:
I've read the Light and Warburton paper and followed this blog and the comments on Slate as well, including Warburton's and Light's contributions. I've also read all the DiMasi et al papers. But I'm STILL waiting for an unbiased analysis!
The choice of words and references in the Light and Warburton paper is poor enough (i.e. unprofessionaly inflammatory and woefully incomplete, respectively), that it naturally calls into question the motivation of the authors, the quality of their work AND the standards of the journal that accepted the manuscript as (apparently) an article rather than an opinion piece. Any valid points the piece has(and I believe there are some) are pre-emptively undermined by the decidedly oppositional tone adopted from the very outset of the article (i.e. the wording of the title).
There are a number of other academic economists who have raised, in mercifully UNheated and objective scholarly articles, serious and legitimate criticism of the TCSDD methodologies, especially the way they use cost of capital and their choice of corrections for inflation. In particular, Boston University School of Management's Iain Cockburn and Harvard Business School's Gary Pisano have written articles that warrant legitimate and appropriately skeptical scrutiny of PhRMA/TCSDD publications (and, in my opinion, the Light and Warburton paper also, since it appears to be based on the TCSDD findings).
Altogether these studies convince me of one thing: we have not yet seen a well-reasoned, unbiased, economically sound figure for the mean or median cost to develop any drug (new, me-too, reformulated, recombined or even placebo). What I'm seeing now is a lot of heat but no light (no pun intended). My opinion, based on the sum total of what I've read from a wide range of sources, is that the most useful number lies (at most) roughly midway between the TCSDD and Light/Warburton extremes.
4. johnnyboy on March 9, 2011 9:47 AM writes...
"...I politely tell them that I'm a researcher in the pharma industry, they're actually quite nice to me and full of questions about what I do and seem genuinly interested. "
Well, it's always easy to bash a big faceless institution when you see it as an abstract concept, like Big Pharma, Big Oil, Big Government, etc... When the bashers are suddenly faced with the realization that these institutions are actually made up of well-meaning people trying to do the right thing, it can open their eyes. Which is why I would urge you to keep talking, so that minds can be changed, one little bit at a time. But I know it's difficult; it certainly infuriates me when I get lectured about all the terrible things done by the pharma industry by some clueless concerned citizen who's read one article (or blog) somewhere.
5. Rick on March 9, 2011 10:04 AM writes...
I'm with exMRK, let's not throw out the baby with the bathwater. Unless we've been in a far remote outpost, most us who have worked in the pharma or biotech industry anytime over the past two decades probably know that it has been deeply concerned about productivity and the "patent cliff" that entire time. Pharma and biotech companies have been trying, and, it seems, failing, to invest in strategies that would avert the problems we now see before us. That is arguably a prime reason for the boom in biotech investment in the 80s, 90s and early 2000s. Some of the decisions, like those involving purchase of chemistry databases, may have been financially sound in the short run but foolish by scientific and long-term value standards.
Let's face it, Slate, like any other online or paper news periodical, has an editorial position that's not hard to detect even if you don't try very hard. But that does not necessarily mean there is no truth behind their difficult-to-take words. You just have to hold your nose, wade through the bullshit and try to find the worthwhile stuff. Let's talk about that.
6. Anonymous on March 9, 2011 10:06 AM writes...
"Honestly, I really think that we should make a bigger deal out of clinical failures in this industry, so that people realize that (1) we're always trying to do something, (2) it doesn't always work, and (3) it costs a godawful amount of money"
Never going to happen. It would require someone to stand up and be accountable. All today's senior management want to be accountable for is their golf handicap and future pension. And anyway Derek, mindless hacks like Scocca wouldn't touch a real complex story like a big Phase III failure with a sh*tty stick. Far too much research and hard work required
7. Kevin on March 9, 2011 10:18 AM writes...
There is also a distinct bias in a lot of media, new and old, against the idea of business for profit. I have some guesses where it comes from but the idea that someone has to make money to run a business seems to be offensive to a parts of media, academia, etc. I work in a company supplying instruments to the pharmaceutical and other industries and we get it too, normally from academia ("You want me to pay for the instrument? You should just give it to me.")
Trying to explain costs of development, overhead, etc and then still having to make a profit for the owners, which may include their pension fund or mutual fund in a 401K doesn't really seem to work. I'm kind of resigned to just being an evil capitalist.
8. PharmaHeretic on March 9, 2011 10:57 AM writes...
I hate to say this but- pharma management did not correct themselves or learn from their mistakes. They simply replaced one set of mistakes (HTS, genomics) with another type (licensing dubious drugs, outsourcing).
The real issues are short-term thinking, sociopathic greed and anti-intellectualism. To an external observer, the promotion of drugs like vioxx, zyprexa and a host of other hyped/scam drugs looks like short-sighted greed. So.. yes, most people would agree with the slate.com position and face it- scientists went along with the shit and still defend pharma management in public phora.
Most people therefore rightly see scientists as analogous to ordinary ww2 era germans who did not speak out against nazism (though that would have got them killed or imprisoned).
9. HelicalZz on March 9, 2011 10:57 AM writes...
Funny, when I think of an industry that, once faced with the loss of its historical revenue stream, suddenly stopped 'trying very hard', the one that first comes to mind is ... journalism.
[And yeah that is entirely unfair - but perhaps deserved in this case]
10. milkshake on March 9, 2011 11:05 AM writes...
most people on the outside do not realize that pharma industry entered the "not even evil" phase of empire decay - the stage when the elites of do not know how to act in the interest of the empire survival. That there are built-in reward mechanisms that encourage staggering bureaucracy, incompetency and suicidal foolishness done on grand scale.
11. Hap on March 9, 2011 11:19 AM writes...
It seems like pharma management believes that they don't need new drugs, though they were trying to do so earlier - the R+D cuts have indicated that managment doesn't think they can develop drugs, so they're hoping that someone else will find them and then hand the money over to big pharma management. Sure.
I wouldn't think that criticizing newspapers for not doing better when faced with TV and the internet is unfair - they were, after all, the ones that figured that raising prices, cutting content, and not doing investigative journalism but trumpeting their politics would keep the cash flowing. At least pharma realizes that new drugs rather than less drugs is what they need, even if it doesn't seem to have a good idea how to do it.
12. Anon on March 9, 2011 11:41 AM writes...
#3 Rick
The choice of words and references in the Light and Warburton paper is poor enough (i.e. unprofessionaly inflammatory and woefully incomplete, respectively), that it naturally calls into question the motivation of the authors
Beware when you raise what are essentially ad hominem issues. Ad hominem arguments are logically fallacious; just because someone's writings are "inflammatory" or (in someeone's judgment) "incomplete" does not imply that what they are writing is false.
Scientists should know that.
13. CMCguy on March 9, 2011 11:46 AM writes...
I am not sure how or if we can fight the dominate misconceptions that are out there about drug development. To a degree I do see that Pharma/Biotech has become in past decades more motivated by profits and not science which has shifted to a short-term mindset (as with whole culture since 80s/90s). On the other hand there is no question that companies have been aware of approaching Patent Cliffs (all do analyis even before going commercial) and as Derek points out there are few successes and numerous failure. I see faults in approaches that sought only Blockbuster replacements, narrowing the fields of research based assumptions on what would lead to a new huge commercial product (a different case of what fools believe). Likewise pushes new "technologies" to make discovery faster and cheaper have been bountiful but largely diversions of resources. And as we often lament M&A have appeared more counter productive to innovation.
I do see scientist share part of the "blame" for decline, or mainly those who advanced to management positions and then did not provide counter balances to moves away from science focus or grabbed on to quick and easy fixes. However to characterize as ww2 ordinary germans per #8 is hyperbolic. I think most scientist become overly focused on their own areas and do not learn or get involved in larger organizational aspects so the might have influence.
14. anon on March 9, 2011 11:49 AM writes...
#7 Kevin
I have some guesses where it comes from but the idea that someone has to make money to run a business seems to be offensive to a parts of media, academia, etc.
So the VP Research Computing at MRL used to complain about the 'high cost' of the medical journals and databases from companies like Elsevier, Dialog and other aggregators.
Teapot calling kettle black.
15. Rhenium on March 9, 2011 11:51 AM writes...
"not even evil" phase of empire decay
Interesting phrase, do you know where it comes from?
16. pete on March 9, 2011 11:56 AM writes...
If there are too many PhDs toiling for too few decent positions, then there are definitely too many writers generating "content" that could best be described as profound-brown-rounds.
17. Anon on March 9, 2011 11:57 AM writes...
most people on the outside do not realize that pharma industry entered the "not even evil" phase of empire decay - the stage when the elites of do not know how to act in the interest of the empire survival. That there are built-in reward mechanisms that encourage staggering bureaucracy, incompetency and suicidal foolishness done on grand scale.
You have it nailed.
18. Rick on March 9, 2011 12:12 PM writes...
@ 12 - anon:
It's hardly ad hominem to raise issues that any responsible peer reviewer should raise concerning the objectivity and completeness of a manuscript's conclusions and references. I'll grant you that there's some subjectivity involved, but there's a great gulf between the partially subjective standard to which an experienced peer reviewer (as I am, in addition to being a scientist) might admit and ad hominem attacks. If we can't distinguish the two, it undermines our ability to debate and reasonably disagree.
If you read my comment more carefully, you will note that I do not simplistically label the article as "true" or "false" as you suggest. Moreover, I suggest that it has some valid points. What I ask for is unbiased analysis and I even offer some additional sources for it.
To quote your closing line: "Scientists should know that."
19. JasonP on March 9, 2011 12:13 PM writes...
"Unfortunately, if enough people believe something idiotic, those beliefs can have consequences."
HEY! This is why I keep posting about reopening the book on Nativis. We cannot allow bogus science to influence people's perceptions because it is bad for all of us.
You said you would talk about Nativis again when they claimed to release patants in a few months. It's been a half year or more now and I still see that company in my town, so GET TO IT!
20. bbooooooya on March 9, 2011 12:24 PM writes...
The Slate piece may be a little inflammatory, but does it miss the mark by that much?
I know myself very smart people in pharma, but they tend not to be the ones making the decisions.
To be sure, drug discovery is tough, and the pharma companies have produced some drugs with real benefits. But, if big pharms were so concerned with R&D, why have marketing budgets been skyrocketing over the past decade? Seems to me a pretty good example of " wringing as much money as possible out of the drugs it already had".
Look at where drug companies are putting their efforts: drugs to give old guys boners (maybe useful, but important?), drugs to lower cholesterol in a country full of lard asses, drugs to treat indigestion (GERD!, even optically pure follow ons), drugs to treat depression (yes, it's a real disease but see recent NYTimes article abt current psychiatric practice), drugs to treat resless leg syndrome.
It's not as though discovering new drugs has become any tougher in the past decade: it's always been hard, and it always will be, it's why drug companies can extract such remarkable profit margins when a drug does get to market.
In business, like in sports or academia, no one gives you a prize for trying hard.
21. Robert Bruce Thompson on March 9, 2011 12:25 PM writes...
>> Maybe it's human nature, but these sorts of troglogytes seem to despise particular groups of people, while at the same time being able to like the individuals who are part of that group.
Well, speaking as a troglodyte, I despise liberals and conservatives as a matter of principle, but I get along quite well with many individual liberals and conservatives.
22. Anon on March 9, 2011 12:54 PM writes...
18 Rick
The choice of words ... is poor enough (i.e. unprofessionaly inflammatory .. calls into question the author's motivations...any valid points the piece has(and I believe there are some) are pre-emptively undermined by the decidedly oppositional tone adopted from the very outset of the article (i.e. the wording of the title).
Nowhere do I see you debate their arguments on the merits.
My Ad hominem comment stands.
23. MoMo on March 9, 2011 1:26 PM writes...
It isn't that Big Pharma hasn't tried to bring new drugs to market, but that discovery teams are now staffed with homogeneous and vapid scientists afraid or unwilling to break from the groupthink and herd mentality. They are afraid of confrontation, controversy and are today dealing with the status quo to pick up the biggest paychecks around.
Then there are the mavericks who surface once in while with a novel and innovative idea, start a company in the small Pharma world, only to be traumatized by their interactions with Big Pharma.
But it is the crazy-irreverent scientists that have the most to offer, and they usually don't fit into the Big Pharma mold, making it on their own while you all search the internet for answers from smug academics and people who refrain from getting their hands dirty.
And we laugh all the way to the bank, while academics publish meaningless papers on Pharmaco-economics, Pharma flounders with science-pussies afraid to innovate, while shareholders groan and moan while their leaders cash in.
It has always been this way, but with the internet just more apparent.
24. Rick on March 9, 2011 1:34 PM writes...
I offered the names of respected researchers who have published many well researched and widely cited articles that tackle these issues precisely on their merits in my post. If you read them, you will find observations far more thoughtful and detailed than a blog post for treating both sides of this debate with grains of salt. I have also offered my bottom line based on my reading of those articles. I recommend them to you too.
On the other hand, if you prefer the ad hominem attack line of discussion, rather than digging a little deeper into the literature, I'll leave you with the old saying "you can lead a horse to water, but you can't make him drink."
25. daen on March 9, 2011 1:45 PM writes...
@22: Let's address some of the subjective and ignorant comments in the paper.
Consider the title:
"Demythologizing the high costs of pharmaceutical research"
It is value-laden. It takes as given that the industry figures are false or misleading. It assumes an outcome already. It is obvious from the paper's outset that the authors have an agenda. Were the paper to be truly objective, "Deconstructing" or "Investigating" or "Producing an alternative framework for" would have achieved the same impact without the implicit value judgement.
"Industry executives, well supplied with facts and figures by the industry's global press network, awe audiences with staggering figures for the cost of a single trial, like tribal chieftains and their scribes who recount the mythic costs of a great victory in a remote pass where no outside witnesses saw the battle."
Inflammatory rhetoric.
"companies are so generously rewarded for developing hundreds of new products little better than the ones they replace. Policy needs to move away from decontextualized magic bullets ..."
Unsupported generalization.
"... it is puzzling that more than half of those invited did not participate ..."
Implication of malign intent posing as innocent speculation.
Use of numerous uncritical quotes from Goozner and Angell imply a serious lack of understanding of the real-world challenges of drug discovery, including obvious lack of comprehension of the differences between target discovery, elucidation of mechanism of action, hit screening and lead compound development.
"the costs of R(research) are unknown and highly variable."
One would imagine that two highly-published health economists would know a little about developing financial models under conditions of uncertainty, but it appears that the best that they can do is to throw their hands in the air and admit defeat.
This is itself either an admission that pharma research costs really *are* that hard to find out, or it is a methodological failing in their paper. Either way, it renders any subsequent figure meaningless by way of comparison with the DiMasi paper.
It is also disingenuous of Light and Warburton to claim that the highlight of their paper, the median figure of $59 mn, is for "only the "D� in R&D" [Warburton response in the Slate article comments section] when their paper refers to "R&D" nearly 100 times, to "research" or its cognate around 40 times and to "development" less than 20 times.
Light's own commentary on Slate contains the interesting non-sequitur (after a half-hearted attempt at defending the paper which I won't quote here):
"The real problem is not the cost of R&D but the strong incentives for companies to focus on developing many new drugs judged little better than existing ones which they can market to physicians and patients. These drugs, however, have harmful side effects with little offsetting advantages. Prescription drugs are now the 4th leading cause of death. The epidemic of 46 million harmful side effects is described in THE RISKS OF PRESCRIPTION DRUGS (Columbia Univ Press 2010 $15)."
Yes, go and buy his book.
All very professional with no obvious agenda.
26. TJM on March 9, 2011 1:48 PM writes...
Scocca's points again reflect what I commented on yesterday. Journalism, and even our society has locked into a mindset that mandates extreme polarization on any issue. Objective analysis and commentary of the kind that Rick wishes for are now the smallest percentage of "shared knowledge" since before the Renaissance. We cannot seem to get any attention unless we are screaming distortions of the truth. How can we change that?
Relative to the whipping boy status of Pharma – these is a rehash of issues since the 1960's, when the industry opted out of Medicare legislation. Therefore millions of citizens only saw drugs as having a direct impact to their wallet. The other 80-90% of heathcare costs that consumers pay is indirect. That made Pharma-bashing an embedded theme in US society. Maybe that attitude will be unchangeable for generations after the industry crashes & burns. Maybe that is why PHRMa leaders see changing that attitude as a unmoveable money-pit. I know that most individual science peers I have known over the decades have altruistic, deep concerns for helping people, families and society. Their efforts just cannot move that attitude needle, especially when "journalists" abandoned objectivity in the 1980's and especially with our current red/blue polarization culture.
#20 bya: The industry profitability has dropped in the past 10-15 years from about 17% to 9% (or so.) If they were not trying to get as much value out of their existing products, that profitability would be even lower, with more R&D sites shuttered and more of prospective healthcare advances being left to governments. Not sure how much more effective they would be in solving unmet needs like Parkinson's, multi-therapy anticancers, etc. As I used to tell folks years ago, when told that Pharma was too profitable: "Since something has to be the most profitable, what industry do you think that should be? Televisions? Autos? Oil? Weapon systems?" Lifestyle drugs are a VERY small percentage of focus, and your comment implying anti-cholesterol drugs are of little value is either intentionally provocative or just naive.
27. Drug Developer on March 9, 2011 1:53 PM writes...
Could anyone go on to clinicaltrials.gov, search for "Open Studies", "Industry-Sponsored", pick a disease state, and NOT marvel at the sheer volume of global drug development going on? Go ahead -- open up an individual study and get a hint of the complexity.
All without getting off your duff, which should be appealing to many who call themselves journalists these days.
28. Barry on March 9, 2011 2:01 PM writes...
I note that the Slate piece talks about failings of business, not failings of science. I have seen failings of science in Pharma (e.g. do we go with the compound with the 10hr half-life or the one with the 10-day half-life?) but they pale to insignificance against the last decade of bad business decisions. Now there are thousands of researchers idled. It's not so clear to me that Scocca is the idiot.
29. Fake Name on March 9, 2011 2:04 PM writes...
Something that I have never understood. How the heck can scientific publishing companies charge extortionate amounts of money for research paid for by tax money? And lets not forget, MRL pays taxes too. If there is one thing compulsory licensing is good for, it is for free dissemination of scientific papers funded by the public.
So if my paper disagrees with another lab's results, can I call them f***ing morons, as long as I publish my data? Do you know of any journal which will let me publish that?
@7, Kevin:
You nailed it. What ticks me off even more is that their salaries are paid for by the extortionate college tuition, inflation in which has been outpacing the economy by multiples. These academicians and their partisans keep talking about Big Pharma, but not a peep from them regarding "Big University".
@23 MoMo:
And the NIH is a hotbed of funding maverick scientists.
@20 bbooooooya:
And what is wrong with drugs to treat ED? Have you had ED? If you did, was your partner happy with you having ED?
I fail to see why drugs treating ED are treated in such a derisory fashion when it is an obvious quality of life issue. Are you against women receiving breast reconstruction surgery for breast cancer survivors? Do you think people don't need to have sex and can be perfectly happy without it? Your argument is no different from the Pope's argument against contraception and abortion.
And as for dugs against indigestion and cholesterol, why don't you blame the consumers for buying them? If consumers stop buying "boner", cholesterol and indigestion drugs then the companies will stop making and selling them.
30. milkshake on March 9, 2011 2:10 PM writes...
@15: The "not even evil" comes from "not even wrong" (a famous put-down from Pauli). I thought of British Empire, post-WWI and Soviet Bloc in 80s, as a close analogy to what is happening with large pharma companies.
When I worked for Celera, the management completely misled and used the scientists (that they needed to save the research site) only to make them work harder, and as soon as the projects got completed to a clinical candidate stage at which point the projects could be sold, the company closed the site and fired everyone. The company did it in a exceptionally nasty way, it cheated the employees of their severance too (and sure enough, no-one sued). I did not like it, but this bare-knuckle behavior made a business sense.
Before Celera, I was Pfizered. Looking back, what Pfizer has been doing makes no business sense whatsoever, it only served the top management and it burned a good pile of investors money.
31. Rick on March 9, 2011 2:26 PM writes...
@ 29 (Fake Name)
"So if my paper disagrees with another lab's results, can I call them f***ing morons, as long as I publish my data? Do you know of any journal which will let me publish that?"
Perhaps I'm missing your point, or your sense of humor, but I don't see we have any disagreement. Of course, you can call competing researchers whatever kind of dim-bulbs/morons/cretins you want in your lab, at lunch, at conferences, etc. when they publish stuff you disagree with. (Indeed, who hasn't said that many times, myself included.) I am most certainly NOT saying you can't. However, if you write it like that in a manuscript for publication, it has no chance of geting past my editorial red pen, nor that of any other reputable journal I know of (unless it's on the psychology of swearing).
32. Fake Name on March 9, 2011 2:42 PM writes...
@31 Rick:
My Bad. My response (that portion) was aimed at "@22 Anon". I do actually agree with you, that tone of a paper is also important (obviously not as important as data). My guess for Light & Warburton's use of inflammatory language was for their paper to get traction, not amongst other academicians and serious researchers but, but people like Timothy Noah and publications such as Slate. Given that I think it is an obvious question, that why did they need to "sex-up" their data? Reminds me of Colin Powell's presentation at the Security Council, replete with satellite and intelligence data.
33. MoMo on March 9, 2011 2:48 PM writes...
Fake Name,
Don't worry-the journals are next in line for a well-deserved beating. Especially since they have been capitalizing on the frail egos of scientists for years. Review journals especially, and I emphasize those for-profits run by cheesy foreigners from Pakistan.
Most of the recent scientific fronts in the past 2 decades in Pharma are crap anyway, including your ED idiom. Combi-chem, DOS, iRNA, anything with omics- attached to it-all need to go away and soon.
Pharma has obfuscated real innovation with Henry Ford-McDonald's buger-line ideas that show the smart ones science can't be rushed.
Any moron in science knows this by now. Now the shareholders?....
34. daen on March 9, 2011 2:55 PM writes...
@33: McDonald's bugger-line? Is this a new service they're offering? [Insert jokes about pickles and buns here].
35. Fake Name on March 9, 2011 3:03 PM writes...
@33 MoMo:
And how exactly is the ED idiom crap?
36. MoMo on March 9, 2011 3:05 PM writes...
Insert the R or keep it as is-It's the scientist that gets the shaft from lazy-let's-industrialize-and Henry-Fordize-Pharma-science managers.
It is at the core of the inability of Pharma to innovate.
37. MoMo on March 9, 2011 3:15 PM writes...
You must derive your existence from ED in some way to back up a serendipidous finding with such zeal, which makes you part of the problem in the Pharma industry.
No one is debating your goal of bringing women to orgasms or causing over-population and crime waves due to aging parental roles, but if you think this is really useful for the human race you are more deluded with grandiosity than is evident.
But this is America and milk it while you can-no pun intended.
But when you fall don't come crying to me. Some of us make drugs that actually save peoples lives, not give them priapism.
38. Cato on March 9, 2011 3:26 PM writes...
So drugs are hard to make, every reader of this blog should be aware of this. However, I think that many commenters here work in the industry and therefore feel (probably rightly) insulted by the suggestion that there has been NO research. Of course there has, and I'd bet you some money that Scocca is aware of this. If you look at the comments in the original article you can see that the discussion there is going a different way - not focussing on NO DRUGS AT ALL, but rather on the broader point that Scocca's polemic is (probably) trying to make: Why are pharma companies spending so much money on other things (marketing, CEO salaries, helicopters - see Pfizer) than research? Yes, putting money into marketing is getting out more than you put in, but isn't this "wringing as much money as possible out of the drugs it already had"?
As advertising is a zero-sum business, the companies could maybe *gasp* lobby for limits on advertising and marketing to physicians and spend the saved money on research? This is not a pipe dream, many countries have limits on these practices. The profits will stay (roughly) the same because people still need their drugs. However, there will be more money to invest in research, so that more drugs can be developed and sold. I would really like to hear arguments against this that are not based on reluctant management etc.
Furthermore, I always feel queasy by all the lay-offs in Pharma. Sure, there are legitimate reasons: focussing on new areas of research or making some optimizations. But if your business model is selling drugs, how can you justify closing the part of your company that is making new drugs? Will they just start licensing exclusively?
39. Fake Name on March 9, 2011 3:27 PM writes...
@37 MoMo:
"No one is debating your goal of bringing women to orgasms or causing over-population and crime waves due to aging parental roles, ***but if you think this is really useful*** for the human race you are more deluded with grandiosity than is evident."
(emphasis mine.)
Are you asserting that women don't need orgasms? Would be news to a lot of women today. So why do you think women should have sex? To give men orgasms? Only for procreation? My initial guess about your agreement with the Pope on contraception and abortion seems to be on the money.
I really hope you don't make drugs with the aim of giving men priapism and if you do, I hope you get sued.
40. MoMo on March 9, 2011 3:39 PM writes...
Wha? The only chemistry the Pope should know is whether to use sodium or potassium nitrate for his workers to keep them in line.
Go ahead and dose America with ED pills for all you are worth, and create all those new flesh-mounds that will belly up to bar for the newest antibiotics as their sins catch up to them.
Meanwhile, businessmen and scientists in Pharma will huddle in their meetings asking "can we make an ED pill for children, the untapped market?"
And your job will be secure for another few years.
41. johnnyboy on March 9, 2011 4:10 PM writes...
On marketing: i'm so effing tired of all the armchair CEOs blathering on about how terrible it is that pharma spends millions on marketing. Do you all think that pharma companies WANT to spend those millions, that they actually ENJOY it, that they think it's GREAT for their balance sheet to have those massive expenses ? Marketing is there because it is NECESSARY to sell drugs. Pharma is a hugely competitive, cut-throat business, where the market is still split between 20-30 major players - even mega-behemoths like Pfizer have what, maybe 20% of the market ? How many other business sectors have this degree of fragmentation, where companies have to constantly fight to not get submerged by all the other players ? The bulk of the marketing budgets are spent not on TV ads, but to pay the salaries of the myriads of sales reps who need to constantly visit MDs to push their products - as far as I know, no one has come up with a better solution. A company that spent all its budget on research, hoping that their products would sell on their own merits, wouldn't last a month. If Scocca has a better business model, maybe he could share it with the world instead of whining about something he knows nothing about, like the rest of the 'shocked and appalled' crowd.
42. TJM on March 9, 2011 4:13 PM writes...
#38 Cato – "…lobby for limits on advertising and marketing to physicians and spend the saved money on research? .. I would really like to hear arguments against this…" I am not arguing against such a shift, but in spirit of objectivity, Pharma has also been scaling back investment in marketing (staff at least.) US Sales staff in Pharma has scaled back at least by 10,000 in the past five years (so R&D is not alone in the pain), and an additional projected 20,000+ in the next four years: http://www.fiercepharma.com/story/sales-force-cuts-have-only-just-begun/2009-01-20 I guess they will be shifting from "brick & mortar" and live bodies to online schemes(?) Dollars invested in marketing probably will not go down. Note that if industry returns are diminishing, then investing in things that offer lower costs, or faster or surer returns is not just good business, it may offer survival. I am an advocate of effective R&D, but R&D dollars take a loooong time to create returns.
Also to your point " …the profits will stay (roughly) the same because people still need their drugs. However, there will be more money to invest in research, so that more drugs can be developed and sold…" Uh, no. Diversification into associated services MIGHT provide a short-term addition to revenues for the industry. But without something new like that, profits from approved products are already on the track to disappear, and those profits (incentives) are what provide monies to invest in R&D. Take away incentives and investments will look elsewhere, which is what we are seeing (.. maybe a bit into some improved productivity plus novel R&D models and tools.)
43. Hap on March 9, 2011 5:18 PM writes...
1) Well, getting paid lots of money to suck is a recipe for a lot of armchair whatevers, particularly when you're pushing over a lot of people to save your own self. I'll be saving my sympathy for the remaining >99% of humanity, thanks.
2) The problem with cutting marketing to save R+D is that it generates more money that it takes in - thus cutting marketing will (in theory) mean less, and not more, money to spend on R+D.
Marketing's increased revenue, though, seems to come from doing things less than savory and from selling drugs to people who don't know better. (The DTC business seems predicated on customers who don't know and/or can't evaluate the benefit/risk ratio of a particular drug, though even doctors and people with lots of info can't do that, either.) When the side effects and consequences hit, the reputation of the parent company is gradually (or not so gradually, such as Toyota) - thus the added revenue comes at the cost of goodwill.
People would be disposed to dislike pharma at some level, because paying a lot of money for things they need is not likely to make anyone happy, but there is no reasonable justification for us to feel that way. (Without the money, no drugs, and perhaps, no life - it isn't a choice anyone likes, but a choice that did not exist before the drugs were there.) Marketing's dishonesty gave people a legitimate reason to dislike pharma. So, the added money came at the cost of goodwill, which eventually translates into money, probably.
Selling too much, and too hard, and dishonestly eventually has consequences, and without the drugs to make people come to pharma anyway, well... (One could argue that the overselling makes it harder for the FDA to trust companies and thus to approve drugs - thus the overselling earlier prevented drugs now and in the future, and thus helped to create the current problems.)
44. Bruce Booth on March 9, 2011 6:31 PM writes...
Great posts on this subject. Reality is the average or median cost for a drug approval is irrelevant since most projects are never near the average or the median. The distribution of value is more relevant. So just for fun, I've posted a model for evaluating the Cost of an NDA on www.lifescivc.com. Figured we could crowdsource to a distributed answer.
45. Karl Hallowell on March 9, 2011 6:39 PM writes...
MoMo, you wrote:
"Go ahead and dose America with ED pills for all you are worth, and create all those new flesh-mounds that will belly up to bar for the newest antibiotics as their sins catch up to them."
When faced with disagreement, the noise increases. This is a solid sign of an irrational arguer.
There are a host of odious little aging-related illnesses that don't hurt you directly in a serious way, but they really mess up your quality of life, such as erectile dysfunction, hemorrhoids, incontinence, arthritis, baldness/hair thinning, tooth loss, and poor eyesight. If we can fix these problems, especially with just a mere pill, then why shouldn't we?
ED drugs can improve the quality of millions of peoples' lives, but all you can babble about is "sins" (presumably the spreading of drug resistant venereal disease). Last I checked, the elderly were a pretty mature group, even though they may have grown complacent in sexual matters. They are more likely than other age groups to have figured out how to have sex without spreading disease.
Finally, it's worth noting that drugs such as Viagra, sell well. That means people want them. As I see it, we have a quality of life issue and we have an obvious demand for a drug to address that issue. It looks right to me. I don't see any reason that you should judge, MoMo.
46. KSH on March 9, 2011 7:03 PM writes...
The complaints about Viagra are pretty funny... I sincerely doubt the researchers were perusing a phosphodiesterase 5 inhibitor with the sole hope of creating a "priapism" drug, they were seeking a more effective vasodilator. Priapism just happened to be a side effect, and a very profitable one. Good for the drug companies, that they could also market it in this fashion - it was a completely unexpected outcome.
47. John Thacker on March 9, 2011 7:14 PM writes...
"Look at where drug companies are putting their efforts: drugs to give old guys boners (maybe useful, but important?), drugs to lower cholesterol in a country full of lard asses, drugs to treat indigestion (GERD!, even optically pure follow ons), drugs to treat depression (yes, it's a real disease but see recent NYTimes article abt current psychiatric practice), drugs to treat resless leg syndrome."
That is where drug companies are putting their *advertising*, especially direct to consumer advertising. It makes sense-- you don't have to advertise a new cancer drug. People who have something life-threatening will seek out the new treatment. However, you do have to advertise drugs for conditions that people might be too embarrassed to mention to a doctor, not be aware that there's a treatment for, might choose to take or not take depending on cost (since they can live with the condition if they really had to), and so on. You don't advertise things that sell themselves.
I'll grant that the actions of well-meaning idiots insisting that drug companies not make too high profits off of drugs that actually save lives does discourage drug companies from going after those kinds of things. It's certainly affected vaccine research.
48. Rick on March 9, 2011 8:38 PM writes...
To 46 - John,
You reminded me of something we used to joke about when I was a scientist at Merck. Ever notice how the target population for many of the best funded research programs and most highly advertised drugs overlaps so nicely with the demographics of pharmaceutical board of directors members (rich old white guys)?
It also reminded me that we noticed that allocations for R&D and advertising for drugs for chronic conditions, especially if they required the patient take the drug for the rest of his/her life, grew while resources for R&D and advertising for cures and curable conditions shrank. It makes me wonder what gets the highest priority: maximizing profits or meeting medical needs.
49. Warts on March 9, 2011 8:53 PM writes...
My take is that something HAS changed over the last 10 years in pharma development. Buisness needs have over-taken science needs. It is a curious vibe to be in a company full of scientists now led by Wharton suits rather than white-coats. Work has become a ritual of quarterly reviews, HR slogans, powerpoints and corporate speak. Can we please do some science and give something back to the shareholders?
50. Pontiac on March 9, 2011 9:54 PM writes...
Maybe the way to look at it is that basic research has failed the drug industry in promising 'starting points' over the last decade?
In other words, maybe it costs a $20billion over 10 years in research to get enough extra info about Alz so that the drug companies can start to do what they do. No private company has the ability, timescale, patience, etc, to make that kind of investment in an uncertain result.
Perhaps it is a public function to get things to the /point/ where private R&D can take over and business competition is meaningful. One could look at some of the problems the industry has been having as not an indication that they are bad at what they do but as a lack of what they need. The answer isn't for the NIH or whoever to do what Merck does - the answer is for the public investment in knowledge available to all to give business and R&D competition the best way to thrive.
51. Anonymous on March 9, 2011 11:01 PM writes...
How can there be new drugs when upper scientific management panders to upper, upper MBA management types by shoving the corporate brain-washing trainings and cr*p like Six Sigma down our throats? I had a recent conversation with a director in my dept, who recommended getting the belt because 1) everyone else is getting it, and 2) Six Sigma "really structures your thinking"...!!! The director had no interest in discussing the current program issues. After all, our new cookie cutter drug development paradigm is sure to to produce innovations. If new drugs require creativity...well then Mother M is sunk.
52. Cato on March 10, 2011 4:43 AM writes...
@41 Johnnyboy
Please read my post again. I am aware of the need to market drugs, particularly in the US without a central body that makes decisions on which drugs to give to patients (i.e. NICE). As you said, it's a cut-throat business with strong competition. But this is because there's only a limited amount of money to go around; society can't afford to spend more than a certain amount on medicine: it's a zero sum business. Therefore, any money you spend on marketing won't increase the overall revenue of drug companies, only your share of it.
Now, if the drug companies really didn't want to spend money on marketing, maybe they could get together and lobby the government for limits on marketing: no more adverts, no more visits to doctors, sponsored lunches, holidays etc. On top of that, very hefty fines that will discourage anyone from breaking these rules and would allow one company to blow the whistle on another company breaking them. All the information going to doctors would be based on cost/efficiency analysis by an independent body (e.g. NICE).
If two or three big players got together and actively sought out stronger regulation, tied together with an enforceable pledge to put most of the saved money back into research, do you think that the public and the politicians wouldn't go for it?
As you suggested, you would like to hear a better business model. Here is mine (again). I would really like to hear criticism of *this* proposal, not a general reply on why marketing is necessary in the current situation.
53. John Thacker on March 10, 2011 10:17 AM writes...
"But this is because there's only a limited amount of money to go around; society can't afford to spend more than a certain amount on medicine: it's a zero sum business. Therefore, any money you spend on marketing won't increase the overall revenue of drug companies, only your share of it."
This is ridiculous and untrue, completely belied by the facts. At the very least, simply note that the percentage of income spent on medicine has increased, not remained stable. While your argument may apply to necessary and life-saving drugs, it does not apply at all to the oft-criticized "lifestyle" drugs that treat non life-threatening conditions that people oft don't even realize that there's a treatment for.
The amount spent on marketing allergy medications, erectile dysfunction drugs, migraine medication, restless leg syndrome, frequent urination/enlarged prostate, and other conditions absolutely does increase the overall revenue of drug companies. It is not a zero-sum game. Some one may easily decide to cut back on buying more expensive dinners, nicer cars, vacations, or whatever in order to have relief from their annoying or debilitating but not fatal condition, particularly if they suddenly find out that there's a treatment for it.
Even where a government board such as NICE exists, and patients are spending only the government (or insurance) money instead of their own, you would have to be incredibly foolish to assume away politics, and think that the people wouldn't petition the government to spend more and cover more drugs. Determining costs versus benefits for a whole population for a lifestyle condition is always going to involve a lot more art and guesswork than figuring out what someone is willing to pay themselves.
54. johnnyboy on March 10, 2011 10:52 AM writes...
@51 Cato: my comment wasn't directed at yours, just a reaction to Scocca and countless others whining about pharma advertising budgets without any understanding of how the business works.
But since you're asking, yes, I think your plan, however nice, is complete pie in the sky stuff. The likelihood of american pharma actually lobbying to decrease advertising is less than nil. Furthermore, any severe restrictions on marketing like you propose would never stand up in court against freedom of speech arguments. The possibility of the US governement setting up a centralized body like NICE, making final decisions on which drugs are covered or not, in the extremely polarized political climate and with the general anti-government tendencies of the population, is more than far-fetched. The fact that such bodies exist in other countries do not make them any likelier in the US, which has very different social and political characteristics, making any centralized plans extremely difficult to implement (notice how essentially every developed country in the world has managed to set up universal health care for its citizens at least 3 or 4 decades ago, but the US still hasn't been able to figure that one out). Even if it was somehow implemented, the NICE would most likely be buffeted left and right by political forces and lobbying, so much so that it would likely be dysfunctional. And one can wonder what data the body's cost-benefit decisions would be based on, if drugs weren't first allowed to get to market - most of the information on a drug's effectiveness in the real world does not come from approval studies, but from post-approval ones.
55. MoMo on March 10, 2011 11:17 AM writes...
Karl Hallowell,
Sure Viagra is a wonder drug-especially for the sex-slave industry in Asia and India and even the US, where slave-children take the full brunt of sildenafils' side effect. But who are we to judge, right KH?
This is America and Viagra and the others have every right to be marketed on TV during children's viewing hours and used by responsible adults.
Meanwhile, in the US, the drug industry spends more time aiming for life-style drugs for your odious problems, while most companies hide then dismantle from their antibiotic programs.
I'll stick with the latter, after all, only antibiotics actually cure diseases, most other drug areas only treat the symptoms.
How is that for rationality, a flesh-mound known as Karl Hallowell?
56. Anonymous on March 10, 2011 1:39 PM writes...
You seem to have a bit of a temper. There are drugs for that, you know...
57. MIMD on March 10, 2011 2:07 PM writes...
#51 I had a recent conversation with a director in my dept, who recommended getting the belt because 1) everyone else is getting it, and 2) Six Sigma "really structures your thinking"
I think most scientists had their thinking structured far better than "six sigma training" by the eighth grade.
Truth is, one competent expert who actually knows what they're doing will always outperform 100 know-nothings or generalists following the finest of process.
cf. Beethoven vs. a group of mediocre musicians.
58. Fake Name on March 10, 2011 2:12 PM writes...
@55 MoMo:
"Sure Viagra is a wonder drug-especially for the sex-slave industry in Asia and India and even the US, where slave-children take the full brunt of sildenafils' side effect. But who are we to judge, right KH?"
MoMo, you hit the nail right on the head. Pfizer single handedly created the sex-slave business. There was no sex-slavery before the evil blue pill was discovered. I really don't know why they call prostitution the oldest profession in the world, when it was just recently created in the 90s.
Developing drugs such as Viagra, Cialis and other lifestyle drugs just takes money away from valuable research in antibiotics. Similarly developing the iPad, iPhone, android tablets (to name a few items), High Def TV, spending money on nice clothes, homes, food also takes money away which could be spent on researching antibiotics. Society is going to hell when we would rather spend money on an iPad (or the latest from Chanel), instead of donating it to antibiotic research.
59. Donald Light on March 10, 2011 3:57 PM writes...
Light & Warburton cost estimate not so bizarre.
Dr. Lowe: If you read our study you will find that our low estimate for the median, net cost of R&D to companies is based on the same data and many of the same ratios and factors used to estimate that the gross, average cost is $1.3 billion.
All we did was correct for some of the inflationary multipliers that the industry-supported economists have been developing over the past 30 years to make the R&D cost estimate as high as possible so that the industry can lobby for more monopoly price protections.
If our corrections are "bizarre," then so is the industry's.
We don't say or believe, as your column emphasizes, that companies have not been doing research and only marketing. In fact, we've all been hearing for years about how big the R&D pipeline is and how many great new drugs are on their way. Just look at the trade association's website at PhRMA.com.
60. Nick K on March 10, 2011 4:28 PM writes...
Perhaps Donald Light will explain how he came up with a figure of $43M when, as other posters have noted, this sum would barely cover the cost of a large phase III clinical trial.
61. johnnyboy on March 10, 2011 4:35 PM writes...
Don't know if "Donald Light" is really Donald Light, but if so, his antagonism against pharma is pretty clear from the tone of the message (notice how patent protection becomes "monopoly price protection"), which to me casts serious doubts on whatever argument his paper is making.
Marcia Angell must make a fair amount of dough from her anti-pharma pamphlets. I can see how others would want to get onto that gravy train.
62. Starfire on March 10, 2011 5:11 PM writes...
I think the problem is really the disconnect between the reality and the image that people tend to have.
From everything I've seen and heard drug research is really little better than throwing shit at a teflon wall to see if it sticks. Of course, you're not allowed to start on the teflon wall right away, there's a nice brick wall to work on first and then thirty other walls to test on before you're allowed to touch the precious teflon.
Most people though, don't care enough to begin to educate themselves about the process. A lot of these people are of the sort who think that science is a magical sort of wizardry, DNA is the mythical grimoire that anyone with a PHD can read like a book, and all businessmen are soul-sucking greedy monsters who have no ability to conceive of anything beyond tomorrow's profits. Big buisnesses are simply giant machines that chew up the people fed into them and churn out blood soaked money hand over fist to their demonic masters.
It's rather depressing. The big issue is that people don't really understand that scientists are not brilliant inventors who just wake up one day knowing some brilliant molecule that will cure cancer and just have to figure out how to mass produce it. It's a process of trial and error so laborious that most of these same people would say "just give up already."
They expect scientists to be right because they've been told you're geniuses. They expect big businesses to screw them over because that's what they think big businesses do. how do you win them over?
One person at a time.
63. MoMo on March 10, 2011 5:24 PM writes...
So how is Pfizer treating you these days? You get free little blue pills?
64. tgibbs on March 10, 2011 5:36 PM writes...
@25 "These drugs, however, have harmful side effects with little offsetting advantages. Prescription drugs are now the 4th leading cause of death."
This is a good example of the sort of statistic that is much less meaningful than it sounds. To see this, let's engage in a thought experiment. Let's imagine an almost perfect world in which the pharmaceutical companies have finally succeeded in developing drugs that cure every ill known to man, including old age--but like all genuinely effective drugs, the drugs themselves carry a small risk of death.
In our (almost) perfect world, the 1st leading cause of death would obviously be the drugs themselves. And this would be true NO MATTER HOW SMALL the risk of those drugs actually was.
65. Karl Hallowell on March 10, 2011 7:46 PM writes...
"How is that for rationality, a flesh-mound known as Karl Hallowell?"
Your whole argument boils down to "think of the children" which frankly is the epitome of irrational arguments. And your derogatory use of the term, "flesh-mounds" indicates you don't take well to disagreement.
I don't know who you are or why you have this mysterious empathy for pedophilia, but revulsion and morality not erectile dysfunction is the true reason the vast majority of people don't commit pedophilia. Hence, drugs like Viagra don't change the moral landscape.
66. fred on March 10, 2011 9:20 PM writes...
Derek, you work for a company that does actual research, so your view may be a tad rosy. I think it is obvious that Big Pharma has very LITTLE taste left for R&D. PFE alone has shed upwards of 90% of its scientists in the past decade. Soon, you'll find more chemists in rubber plants than med chem laboratories.
67. Hap on March 11, 2011 11:26 AM writes...
Wow. I'm really hoping that #59 is a troll and not one of the actual authors.
In case not, phrase translation...
"monopoly price protection" = patent protection (as noted in 61)
"correct for some of the inflationary multipliers" = pull some numbers out of my rectum that I like and that agree with the policies I want.
You know, that part of "Science: Good For Anything Else?" about the world being indifferent to our whims might be a good idea for #59 (assuming again not a troll) to keep in mind. While capitalism is a human system, numbers and resources are pretty inflexible, and aren't required to obey our desires for their meaning. They also tend to have consequences which aren't required to obey our desires, either.
68. MoMo on March 11, 2011 12:27 PM writes...
Flesh Mound Hallowell
"drugs like Viagra don't change the moral landscape"
No, But it sure extends it! C'mon FMH! Pedophiles should be chemically castrated as soon as convicted, then sent to prison for life and used for clinical drug studies until death. Then the costs of bringing a drug to market would go down, which is what this thread was originally about.
Your over-intellectualization of my comments indicates that you were ignored often as a child, and need to comment on others to regain the lost feelings of love and attention you were deprived of. That could be also why you write using flowery and bombastic prose.
I hope you get better, and drugs, especially those that treat symptoms, could help.
In the meantime, let's see what Light's comment generates in the blogosphere here.
69. Anonymous on March 14, 2011 11:35 AM writes...
Um... I think a couple of you guys are confusing Derek's blog with each other's wall on Facebook. Why don't you go over there? Or maybe you could challenge each other to a duel or something.
Send us all pictures of the aftermath.
70. Yep on March 16, 2011 3:58 PM writes...
The Slate article reads like an Onion piece, I even looked around to make sure it wasn't really a satire on the Onion site.
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October 8, 2015
WASHINGTON (AP) - Congress has reached the homestretch on a major overhaul of federal transportation programs that is critical if the nation is to avoid steep cutbacks in highway and transit aid.
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We are an author-driven publishing house that devotes all energy to the fresh, cutting-edge, and literary voices of our authors
Published Date : November 13, 2012
Fairy tales are one of our earliest cultural forms, and forests one of our most ancient landscapes. Both evoke similar sensations: At times they are beautiful and magical, at others spooky and sometimes horrifying. Maitland argues that the terrain of these fairy tales are intimately connected to the mysterious secrets and silences, gifts and perils.
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This afternoon, the Plaza's Food Hall will expand, adding ubiquitous brands Lady M, Luke's Lobster, Sushi of Gari, William Greenberg Desserts, Tartinery and Pain D'avignon among others. Overall, the move not only verifies the success and relevance each brand possesses but more importantly demonstrates an aggressive move for the Plaza to re-brand its Food Hall. While the Food Hall has enjoyed some success since it opened in 2010, it was always confronted with the challenge of overcoming prohibitive prices for mediocre food.
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I love to read. I know I've said this before but I do. Back in the day, I would read a book or two a week (especially when I commuted into NYC and had 60+ minutes to kill on the train each way). On vacations where we sit on the beach or by a pool, I can usually read a book a day. But not so much anymore. Because I spend most of my day reading for my job, sometimes the last thing I want to do at night is read more. Unless I get a book that immediately grabs my attention, the kind which I clamor for some time to finish and may even blow off plans in order to sit and read. Yet lately it seems these books have been to far between. Until The Double Bind, my latest book club book.
I do not know why this book grabbed me from the beginning. Maybe because we're immediately introduced to Laurel, a graduate from the University of Vermont in Burlington (a school which I strongly considered). Or because Laurel is (was) a biker, like me. Or because she lives in Burlington and rides (rode) in Vermont (in areas I recognize) or perhaps because she suffered a trauma recently and, in a way, so did I. I'm not sure, but I know once I started to read Laurel's story and identify with her and her environment, I wanted to unravel the mystery of the homeless man she knew, and the photographs he possessed when he died, which may indicate that he was somehow involved in her life and the trauma she suffered.
The book moves quickly with suspense (which I normally don't like) and I highly recommend it. Since the book also brings to life characters from another American Novel, The Great Gatsby, it might not be such a bad idea to have read or at least be familiar with that story before you read this (wish I had re-read that first too).
Now, if you're going to read the book, don't go any further.
I definitely may spoil the ending below, so this is your last chance to stop!!
I've been known to read the end of the book, or the last page, before I actually finish the story, especially in a suspense novel and especially when I like the protagonist, because I don't like it when bad things happen to people I like (or at the very least, I want to be forewarned). But I didn't do it here. So when I figured out what was going on, it hit me like a ton of bricks in the same way The Sixth Sense did - and I don't want to sound cocky but it's rare that a book or a movie can surprise me.
Now with this one, I did figure it out the shocker behind our mysterious patient, before it was revealed (there were clues) but part of me wants to go back and re-read the book and identify all of them. I think because the author kept this moving at such a fast-pace, he was able to intersperse a lot more clues and foreshadowing than I picked up on and I would love to go find them all.
I'm looking forward to our book club discussion and would love to hear from others who have read the book as to what they think.


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In the hours leading up to the start of the 2011 First Year Player Draft, one word described the air among Orioles fans: confusion.
For weeks, Baltimore fans had seen their club connected to high school right-hander Dylan Bundy and University of Virginia lefty Danny Hultzen. On the eve of the draft, however, new rumors linking the birds to Bundy's fellow statesman and prep right-hander Archie Bradley intensified. Members of several national media outlets reported that Baltimore had begun conversations with Bradley late in the game, sending feelers for bonus demands.
To throw another wrench in the works, Rice 3B Anthony Rendon, a lock for a top two selection over much of the season and a player heavily connected to the Seattle Mariners with the second overall pick, slid off of the top of the board. As expected, Pittsburgh selected UCLA hurler Gerrit Cole with the first pick. Unexpectedly, Seattle passed on Rendon, turning not to another position player as many had speculated, but to Danny Hultzen. The Astros picked Cole's teammate Trevor Bauer, and both Rendon and Dylan Bundy, along with Archie Bradley, had fallen into the laps of the Orioles.
As it turned out, Rendon had further slots to fall, and the Orioles gleefully announced their selection of Orioles Nation favorite Dylan Bundy. Some 2011 inconsistencies and a less-than-sufficient medical report turned some teams off of Rendon, and Orioles Scouting Director Joe Jordan said they took who they believed was the best player available. Foregoing hesitation due to bonus demands (Bundy reportedly sent teams requests for a 5-year, $30 million dollar deal), Baltimore confidently selected an elite high school talent. The remaining rounds included a slew of college pitchers and a handful of enticing names, but the big story in the draft was the big arm at the top.
Fraternal Ties
The name called by Baltimore on Monday was a familiar one. Dylan Bundy's brother, Bobby, is currently pitching for Hi-A Frederick and was on the hill at the time of the draft. After completing the first inning, Bobby Bundy returned to the dugout to receive word via text message that his brother had been selected by the Orioles.
"I couldn't explain or put it into words how excited I was," Bobby told reports after the game.. "he wanted to be with me. It was kind of his wish. So it's been a dream come true so far. Hopefully he will sign soon and be here with me in the Minors."
Dylan and Bobby later prognosticated that they would arrive together in the Major Leagues in 2013. That might seem crazy considering that, just a few weeks ago, Dylan was finishing up his final exams during his senior year of high school. But Dylan Bundy is the rare high schooler with enough polish and feel for pitching that he could rocket through a system in short order.
With a fastball that has hit triple digits this season and sits comfortably in the 94-96 range, Dylan Bundy brings the type of heat characteristic of a power-pitching ace. He mixes in a cutter, from which he can subtract to get a more slider-esque plane, a true curve and a developing change-up. Above average command and control of a deep four pitch arsenal and plus velocity afford Bundy all the makings of a front-of-the-rotation pitcher.
College Arms Dominate Day Two
After selecting a fire-balling high school pitcher with his first round selection, Joe Jordan shifted the focus to college arms, with a few bats mixed in. The complete list of picks can be found at our 2011 Draft Tracker, but here are some quick rundowns on some of the notable selections:
Round 2: Jason Esposito (3B, Vanderbilt)
Esposito is an interesting prospect. After positioning himself well for a jump into the first round before the season, the Vanderbilt third baseman hurt his stock some with a poor showing in the wood bat Cape Cod league and an inconsistent Junior season at the plate. Some have questioned his bat speed, but he seems to have enough in the tank. He is strong enough to inside-out pitches, and can turn on fastballs every now and then. Most important will be cleaning up his approach at the plate. Early struggles led Esposito to press at times, and his plate discipline suffered for it. Still, he's a solid defender at third and his bat presents enough upside to give Esposito the ceiling of an above average starting third baseman in the Big Leagues. As a system that does not have a good track record of developing bats, Baltimore has a nice challenge in Esposito.
Round 3: Mike Wright (RHP, Eastern Carolina University)
Mike Wright lives and dies with his fastball, a power pitch that sits 94-95 and can touch 96-97 when he reaches back. His breaking ball and change both need a good amount of work if he is to be developed as a starter, which seems to be the plan at the moment. His path could be accelerated with a switch to the bullpen, where his stuff would play nicely as a power arm for the late innings. One saving grace for his chances of starting is his ability to induce groundballs. Still, Wright will need to change speeds and eye levels better if he wishes to face ML hitters two or three times through the lineup.
Round 4: Kyle Simon (RHP, Arizona)
Simon did not light up radar guns in college, sitting 86-89, but on a more manageable pitching schedule he should be able to sit in the low-90s. He pitches out of a low 3/4 slot with good deception. With his arm angle, everything moves with good late life. With the increase in velocity, his strikeout numbers should go up. Like Wright, he'll be developed initially as a starter, though his future might lie in the middle innings. The key to determining his future role will be his ability to command his breaking ball, a difficult feat out of such a low slot. Like Wright, Simon also wracks up the ground balls when his stuff is working.
Round 6: Nicky Delmonico (3B, Farragut High School)
It's a good thing Delmonico was listed as at third base, because his experiment behind the plate has largely been a failure. He shows very raw actions and a weak arm at the position. He is athletic, however, and his future will be either at a corner infield or corner outfield position. Delmonico has some raw pop in his bat, and could potentially develop into an above average overall hitter. Thought to be a round 2-5 pick, Delmonico's stock dropped due to a back injury and an inconsistent senior year. He's told teams that he is looking for a 1.5 to 2 MM bonus, and unless he's willing to back down some on those demands, he'll be heading to college next year.
Round 8: Johnny Ruettiger (OF, Arizona State University)
Ruettiger was a hard player to scout because he's largely been relegated to left field in college. He is quick enough to cover solid ground in center, however, and shows good instincts in the field as well. As a center fielder, his bat plays much better. He hits for very little power, but shows an excellent, patient approach at the plate and average to above average contact skills. In the mold of Matt Angle, Trent Mummey and Kyle Hudson, Ruettiger won't wow you with tools, but if all goes well with his development, he could end up a starting center fielder with good on-base skills.
Round 10: Tyler Wilson (RHP, Virginia)
With its tenth overall pick, Baltimore grabbed a solid starter on an excellent Virginia team. Due to Wilson's arm action and frame, he's likely a reliever going forward, but he emerged as strong starter for UVA in 2011 after spending his first three seasons in the bullpen. He brings low 90s heat, some deception and good control – posting an 11/2 K/BB ratio in his senior year with the Cavaliers. He was drafted in 2010 by the Reds in the 35th round, but choose to return to UVA after a somewhat disappointing Junior season. It's tough to imagine him holding up as a starter, but Wilson could be a nice, quickly moving relief prospect for Baltimore.
Round 12: Jason Coats (LF, Texas Christian University)
Falling all the way to the 12th round, Coats might end up Baltimore's best value pick if he signs. He'll look for round 3-5 money (400-500K) but could be worth every penny. An average left fielder, Coats doesn't have much defensive value, but he might have the best bat of the Orioles 2011 draft. He posted a .361/.401/.617 line last year, and positioned himself as a bat that should go in the first two rounds. He regressed some to .325/.403/.518 this season, leading some to label him a product of the old college bats. While his power numbers were down (as were those of NCAA in general), there were some encouraging signs. He showed the best plate discipline of his career, striking out less and walking more. There seems to be some real power in there if it can be harnessed at the next level, and when all is said and done Coats could provide an above average ML bat.


text: (Newstalk 870-Growing Forward Services) [ Grow Forward in Your Life with Paul Casey [AUDIO] By John McKay April 25, 2013 Time for another installment of Growing Forward, with Newstalk 870 and Paul Casey. Read More|Comment Category: Health & Fitness Tags: growing forward Send to a friend! Share on Facebook Share on Twitter Pin it! Reddit This! Share on Tumblr!


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The upside to this story is, although a movie encouraged a kid to go out and do a stupid thing, at least he didn't get hurt or hurt anyone else. Instead he just comes across as kind of weird and damaged.
Todd Kapcsos (how the hell am I supposed to pronounce that "c?") was out in small Pennsylvania town just lurking in the bushes and practicing some ninja moves in his ninja outfit when some folks called the cops because he was creeping people out.
When asked why he was doing such nonsensical things, Todd actually had a pretty decent response. He said, "There's not enough police officers. I mean there's not enough. The community should do something rather than sit back."
This comes in the wake of a stabbing death in the small town of Moxham. When teenagers are angling to solve a city's crime problem, rather than contribute to it, it's time to staff up police.
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Posted by Dominic Basulto
Joshua Schachter, the founder of del.icio.us, has some exciting news about a recent infusion of VC money:
"As you may know, I left my job a few weeks ago in order to devote myself full-time to del.icio.us. In order to make that posssible, I accepted an investment from a group of thoughtful and influential investors. The group I chose to work with understands my commitment to maintaining the integrity of the service and the security of your data. They were also willing to take a minority stake, which will keep me in control of the future of del.icio.us.
Union Square Ventures leads the investment group, and the other members are Amazon.com, Marc Andreessen, BV Capital, Esther Dyson, Seth Goldstein, Josh Koppelman, Howard Morgan, Tim O'Reilly, and Bob Young."
In his post "Del.icio.us Dollars," Om Malik speculates that del.icio.us received somewhere around $2 million in VC financing. "Open media dollars are coming thick and fast," he writes.
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Pinterest is one of the fastest rising social media platforms. It attracts both bloggers and non-bloggers alike. Recently, brands have hopped on an have begun using it to promote their goods. It's similar to Tumblr in that it shows the viewer hundreds of gorgeous photos. It's a virtual eye candy store.
Recent studies have shown that Pinterest drives more traffic to sites than millions of Google+ users. That is one huge boat that we all need to be getting on. Hopefully, it won't sink.
Just like Facebook and Twitter, Pinterest has certain rules of use. Not the ones that are in the sites guidelines but more like an unspoken code of conduct.
- Make sure to follow other Pinterest users from your particular industry.
- Follow Pinterest users that have similar interests.
- Choose Pinterst users that are in your target audience, people that would benefit from your brand.
- If there are infographs that are related to your brand, use them. If not, have them developed and start pinning them. Infographs are big on Pinterest.
- Make sure to repin others pins, particularly those who are in your related industry.
- Use your business name for your account.
- Fill out the About You section that appears under your photo so that your followers know…about you.
- Get creative with the board names. Have fun with it.
- Feel free to pin videos!
- It's ok, go ahead and Pin your own stuff. See "Don'ts" for what not to do with that.
- Always add a description to your pins. Make sure to change the descriptions written by others to make yours unique.
- If your selling something, add the price to your pin. That's OK, you CAN do that.
- Consider hosting a Pinterest party to create your brand awareness.
- Have your Pinterest settings repin everything to your Twitter and Facebook. They become more of an annoyance to those who follow your timelines.
- Create boards strictly for your own business. It presents itself too spammy and too self-promoting to do that.
- Use your brands Pinterest account for personal pinning. Just like Twitter and Facebook, personal accounts should be completely separate.
- Use Pinterest if your brand isn't quite compatible. For instance, if you are a dealer in nuts and bolts, you might not gain followers due to fact that Pinterest users are there looking for the pretty. But, if you are a shop that creates brilliant floral displays, then you've found the perfect platform for your voice.
Pinterest is fun and it's so visual that it creates a big, time suck black hole. So, my last piece of advice to you is…use caution when entering the Pinterest realm because you may never leave.
photo: google
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French label Equipment is loved for its use of the finest silks, so its sumptuous take on sleepwear is sure to be an instant hit. Made up of a button-fastening shirt and drawstring pants, this brushed set - in fall's must-have metlot hue - will redefine your pajama collection.
Merlot brushed-silkViolet piping, breast pocket, partially elasticated waist, slant pocketsButton fastenings through front of top, drawstring waist at pants100% silkDry cleanDesigner color: WineCome with a matching pouch
Product code: 316289 - Need help? Contact us


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Charlie says, "At the restaurant, oftentimes we take single food stuff—mushrooms, salmon, radishes—focus on several ways to prepare them, and serve each preparation together featuring what I like to call a "conjugation" or "study" of that item. In this case, we are using celery root, mistakenly underrated, underappreciated, and overlooked, but it is extremely versatile. For this dish, we prepare it five ways: roasted in a salt crust, poached in a method called "sous-vide", braised in red wine, pureed, and raw in a simple marinade. At the restaurant, we sometimes take the raw marinated version and emulate the idea of making ravioli by filling them with something like a non-dairy cashew cheese. Also, we dehydrate thin slices or julienne pieces of celery root and use them as a crispy garnish."
A Celery Root Conjugation
Makes 4 servings
Herbed-Salt Crust Roasted
This method is almost like a slow roast or confit type of cookery. The aromas from the herbs will permeate the celery root as it cooks.
1 fresh bay leaf, dried in the oven or in a small skillet
3 rosemary sprigs
3 thyme sprigs
8 large egg whites, at room temperature
1 cup kosher salt
1 celery root, about 2 pounds, washed and leaves trimmed
Kosher salt
Freshly cracked black pepper
Extra virgin olive oil
Preheat the oven to 350°F.
Roughly chop the herbs and set aside. Place the celery root in an 11-inch ovenproof baking or gratin dish. Whip the eggs whites to stiff peaks. Fold in the salt and the herbs. Pour this mixture over the celery root to evenly coat it. Bake 3 1/2 to 4 hours or until the celery root feels tender when pierced with a skewer. If the crust starts to brown too soon, place a foil tent lightly over it for the remainder of the baking. Handle carefully as the crust will be very hot. Let cool on a wire cooling rack.
When cooled, and easy to handle, trim away the crust. Cut the outer brown layer from the celery root, then cut into desired shapes or slices. Season with a little salt, pepper, and a drizzle of extra virgin olive oil.
Slow Poached Sous Vide
By placing all of the ingredients into what is essentially a vacuum-sealed bag (also known as cryovac) and poaching slowly in a liquid heat environment, the flavors are concentrated inside the airless package. With this method, the prepared celery root has an extended shelf life in the refrigerator and makes for a very convenient and clean way by which to prepare and serve.
1 cup 3/8 inch diced celery root
1/3 cup soy sauce
1/4 cup Japanese yuzu juice
1 Thai chile
Pinch of kosher salt
Place the ingredients into a small bag made for cooking with sous vide and seal according to the vacuum sealer instructions. Immerse the bag into a pot of simmering water and cook until the celery root feels tender, 30 to 40 minutes. Remove the bag and cool on a wire cooling rack. At this point, the bag can be kept in the refrigerator or frozen.
To serve, pour the contents of the bag into a small saucepan. Reheat over a low flame. Adjust the seasoning to taste.
Red Wine Braised
This is a very simple way to prepare celery root since it is an ingredient that can pair with assertive flavors like wine. In this recipe, the cumin seed adds a little bit of an exotic note.
1 1/2 cups 3/8 inch diced celery root
2 cups dry red wine
2 teaspoons cumin seeds, toasted then finely ground
Kosher salt
Freshly cracked black pepper
Place the celery root and wine in a small saucepan and bring to a boil over medium heat. Lower the heat, adjusting as necessary, to maintain a slow simmer. Cook until the celery root is tender, 12 to 14 minutes. Add the cumin and season to taste with salt and freshly cracked black pepper. Hold over a very low flame until serving.
This simple method deviates from the method for braising and doesn't call for any cream or butter. When making the puree, you can omit the cumin seeds given in the braising recipe for variety in the finished dish. This is a time to use your best olive oil.
Red wine braised celery root (recipe above)
Extra virgin olive oil for seasoning
Drain the celery root or remove from the braising liquid with a skimmer. Puree with an immersion blender or in a food processor, adding a little warm water if necessary to create a smooth consistency. Pass the puree through a fine mesh strainer. Whisk a little olive oil into the puree to taste. Reheat in a double boiler or saucepan set over a very low flame, stirring from time to time.
Marinated Raw
This couldn't be more simple. It is also used at the restaurant when we make our non-dairy raw version of ravioli filled with cashew "cheese."
10 slices celery root cut 1/8-inch thick
Rice wine vinegar
Extra virgin olive oil
Kosher salt
Freshly cracked black pepper
Cut each slice of celery root into two 2-inch round circles using a round or cookie cutter. Place on a baking sheet or platter large enough to hold the celery root in a single layer. Splash each piece with a little vinegar and lightly drizzle with the olive oil. Let rest for 20 minutes to marinate and soften. Just before serving, season each piece with a little salt and pepper.
For completing the dish:
One recipe of each method for preparing conjugation of celery root:
Pureed (one recipe, see above)
1/2 cup vinaigrette seasoned with coarse mustard, for garnishing
Herbed-Salt Crust Roasted (one recipe, see above)
Red Wine Braised (one recipe, see above)
Slow Poached Sous Vide (one recipe, see above)
Marinated Raw (one recipe, see above)
1/4 cup basil or other herb infused oil, for garnishing
Place a dollop of puree to one side of each serving plate. With the back of a spoon carefully spread the puree to resemble a swipe diagonally across the plate. Drizzle some mustard vinaigrette over the surface of the plate. Cut the roasted celery root into 3/4 inch thick slices, then cut the slices into 3/4 inch thick batons. Season with salt, pepper, and olive oil. Arrange a free form stack on each plate. Arrange the braised, poached, and raw celery root around the plate. Finish with a light drizzle of basil oil. Serve immediately.