The Futile Cycle

For some reason, today I got to thinking about Bill Clinton’s class day speech at my graduation, where he kept repeating that humans are essentially 99.9% genetically identical; he used it to demonstrate why we shouldn’t emphasize our differences, but instead our similarities and find our connections. It’s an admirable moral goal, anyway, from a political point of view.

But if you look around, it’s relatively easy to find patterns that can roughly categorize people into races. I am Asian. It’s very easy to tell, from my hair color, my skin color, and the bone structure of my face. I’m a bit of a lightweight when it comes to alcohol, and I get that “Asian glow” after a drink or two. Some of my friends are very, very white. Some are Hispanic, some are African-American, some are Middle-Eastern. We can see all this polymorphism, so clearly the 0.1% does make a very big biological difference. After all, genetically we are something like 98% similar to chimpanzees, and yet we see huge differences. 0.1% of 3 billion bases is still 3 million bases.

So I looked around on the internet, and found this old, but wonderful, PLoS interview with Neil Risch, a population geneticist, who in 2002 published a refutation of an NEJM opinion article dismissing the clinical relevance of race. So really, that whole 99.9% thing is a bit misleading, since that 0.1% matters a great deal. So why mention genetics at all? Genetics has no real relevance for big-picture global issues of politics, war and peace, and all that, or for social issues on the level of being kind to each other.

And really, there’s no need to make that sort of weak genetic argument. You can look around and see for yourself that humans are pretty much similar. Everyone is born on basically the same pattern, with mothers and fathers, relatives, with mostly four limbs, two eyes, a nose and mouth, with a brain that loves, a mouth that talks, a heart that pumps, hands that grasp. A smile is a smile in every culture, a laugh is a laugh. There are variations on this theme, especially with modern medicine and technology, but mostly people are the same. We don’t need the human genome project to tell us that. Basing your ethical tenets on really shallow inferences from biology is usually not a good idea. Leave biology for biology and medicine, and just look around.

An Op-Ed in the New York Times by Mark Helprin proposes indefinite copyrights. It’s the most ridiculous proposal in the world.

Copyrights and patents are of a limited term for the public good. The time-limited monopoly that Congress gives to authors and inventors are to encourage them to produce their works through the incentive of the additional profit that the copyrights and patents give. The time limit means that ideas eventually revert to their natural state, of being reproducible by anyone, anywhere. It’s all for the public good.

Monopolistic competition (i.e. copyrighted works competing against each other) isn’t quite as good for the public as pure competition (uncopyrighted works competing against themselves). For works not under copyright, it benefits the people not only by allowing for new intellectual works to be seeded, but also by creating lower cost books through the competition of printers, who no longer gain a large profit from exclusive licensing of a copyright. Eventually, the reader would only have to pay for the physical production of a book. Just look at how inexpensive old books are! You can buy Macbeth or the King James Bible for under $6. You can download and read Mary Shelley’s Frankenstein for free on Project Gutenberg, because there are no printing costs.

But we need authors to produce these things, and if anyone could just copy what someone put all that effort into, he or she might not make it in the first place. So we give them copyrights, to allow them to make money from their work.

The author seems to think that holding a copyright indefinitely is a natural right, on the level of the right to property. The author clearly does not understand that ideas are not a protected property. Here, he says,

We have different words for art and idea because they are two different things. The flow and proportion of the elements of a work of art, its subtle engineering, even its surface glosses, combine substance and style indistinguishably in a creation for which the right of property is natural and becoming.

In the natural order of things, I have a perfect right to imitate you and anything you do; to allow otherwise would be to restrict my free will. Art and idea, I agree, are two different things; art is a subset of ideas, at least in one conception. Physical works of art are not ideas; they are the manifestations of an idea, and thus covered by property rights. I can’t take a painting from you without your consent; on the other hand, nothing should stop me from buying an imitation, because the idea of image and form structured in such a way on a canvas is free to the world. It is actually not “natural and becoming” for ideas and art to have a right of property attached. No “creation” is naturally protected under the natural rights.

The fact that art takes effort to create doesn’t mean that it’s worthy of a natural right for reproduction. Should I be restricted from reciting Martin Luthor King, Jr’s “I have a dream” speech, because he worked hard on it? Should I be forbidden from quoting G. K. Chesterton, because his quotes are so witty? No! The natural order of ideas is to be spread out and reproduced by other people, whether orally or by writing (which is just a proxy for oral speech).

The copyright is a grant from the government to an author – a gift, not a right. The copyright exists in the first place, not for the author, but for the public, because we presume that there is some societal benefit from encouraging writing and invention. That’s also why the copyright (and the patent) is of a limited time, because society draws benefit from allowing for ideas to be reproduced. Think about all the benefit that might come from a science fiction writer who find Star Trek to be a great medium for their voice. Or a social activist who thinks that using Disney characters or “Scrubs” characters would make for a more compelling medium to convince other people. Or even just for those random fans who want to draw their own comic books and write their fan fiction set in the world of Batman and Harry Potter. Can you really argue that “The Complete Works of Shakespeare (Abridged)” and “Rosencrantz and Guildenstern are Dead” are not valuable contributions to society? These would be barely possible if the copyright for Shakespeare were still extant. We give authors copyrights so that they give us these worlds and ideas, but eventually we want ideas to return to the public discourse, to go back and seed the creation of new ideas.

That is why copyrights are of a limited term.

(via Greg Mankiw’s blog, Edward Glaeser, a quite well-known Harvard professor of economics, has a wonderfully written piece on environmentalism, and how to implement environmental policies well. He talks about various hidden costs and downsides to certain environmentalist policies that can undermine the good intentions of the movement to stop global warming, such as the ineffectiveness of emissions standards as they are implemented today, the counter-productiveness of conserving suburban greenspace (urban development is one of his specialties), and the problems of the patent system in encouraging environmental innovation.

I’m a big fan of Ed Glaeser’s work, and I found him quite entertaining as a professor. Sometimes he might come off as an arrogant, aristocratic know-it-all, but he’s also absolutely brilliant and witty.

First, the direct-to-consumer side of things. A recent NEJM article raises a good point about the legal feasibility of congress banning direct-to-consumer ads; there’s the first amendment, after all, and there’s a history of the Supreme Court overturning federal bans on the advertising of a variety of substances in the interest of public health, including alcohol, tobacco, and so on.

I, for one, don’t believe that direct-to-consumer ads have any educational value whatsoever, but the preservation of the freedom to advertise in a public forum is very important. We want to make sure that there is enough freedom for things like political advertising, but we also want to make sure that advertising that lowers the overall societal welfare, such as direct-to-consumer ads, get regulated, or even banned. After all, the first amendment is primarily oriented towards politically motivated speech.

Another article, from a few weeks back, was “Following the Script”, from the April issue of PLoS Medicine. It reveals a window into the world of pharmaceutical drug representatives (Drug Reps), who market pharmaceuticals to doctors. Of course, drug marketing is very similar to other business-to-business marketing, in that there is endless networking, false smiles, gifts, hand-shaking, memorization of personal details, tailoring of the message to the target, and so on. Still, the article does show how these are applied specifically to doctors. I really enjoyed reading the table showing how the marketing is tailored to the doctor’s personality. Particularly interesting is the way they approach the “Aloof and skeptical” doctor:

I visit the office with journal articles that specifically counter the doctor’s perceptions of the shortcoming of my drug. Armed with the articles and having hopefully scheduled a 20 minute appointment (so the doc can’t escape), I play dumb and have the doc explain to me the significance of my article.

The intent of the marketing is not education, no matter what the drug companies might claim. Marketing is always about sales. After all, (as the article says) “If detailing were an educational service, it would be provided to all physicians, not just those who affect market share.” Still, one cannot deny that there is currently no good substitute for drug education by drug companies. Even though studies show that doctors still accept gifts from drug companies, drug reps do accomplish getting the name of obscure drugs out, and they do distribute scientific literature. Doctors are busy people; they don’t have time to trawl through the literature all day, as it takes time away from patients. A short blurb from a drug rep can be better than nothing.

In addition, the whole situation marketing situation is a giant prisoner’s dilemma; if a drug company decides to be “noble” and not market to doctors, it will lose sales pretty quickly to the drug companies that don’t have such idealism. There’s really no good incentive for drug companies to stop marketing. If one has to criticize anyone, perhaps one should criticize the doctors for being so easily swayed; but doctors are human, after all, and marketers are very, very good.

Perhaps the group the public should really criticize is the AMA, which for all its statements of ethical guidelines for gifts to physicians, still sells a demographic database to drug companies for more than $40 million a year that allows drug reps to figure out the prescription habits of each individual doctor.

Paul Graham has some interesting ideas on the birth of unions. He’s a very intelligent man, and makes some very thought-provoking points. I’m not an economist, and I don’t have the data to agree or disagree with him, but if his analogy is correct, it could easily be extended to biotech.

Right now industry has a reputation for pouring money into research, as the pace of output has been, so far, much more important than the small salary increase of a chemist, or the price of, say, an NMR tube. Academic labs make graduate students wash and reuse these expensive tubes (which can easily run to more than ten dollars each), but which industry labs throw away, because it isn’t worth the valuable labor time of the researcher to wash the tubes. Most likely someday in the future, when biotech and pharma isn’t growing as quickly, such lavish costs will be cut, and researchers will be paid much less for their time.

In the Pipeline has a nice post about why it’s kind of hypocritical that Brazil break Merck’s patent on an HIV drug. Seems all sorts of disputes are occurring these days as drug development becomes a more international issue, and as poorer nations become wealthier, but balk at the responsibility that such wealth comes with. Novartis has been having similar problems with the Gleevec issue, still.

As always in a society largely governed by utilitarian concerns, triaging is a huge aspect of policy and the distribution of goods by the government. We have limited abilities to provide, and mostly, whenever a government program provides, the problems it addresses grow to meet the budget of that program.

Thus, Peter Schuck and Richard Zeckhauser (via Greg Mankiw) write about triaging and getting rid of “bad apples” that tend to ruin good programs for others, whether it’s the constant disruptor in housing and schools, the chronic freeloader in welfare, or even those negligent patients who don’t take care of themselves properly. I definitely think that triaging health care is something that needs to happen. I don’t really think that universal health care will be that feasible, and even if some minimal system of that sort does occur, it won’t cover all goods and services. There will still be triaging, regardless of how much the government spends on medicine or other welfare programs, because costs always increase to meet and exceed the budget of that program (and as the budget grows bigger, a larger percentage goes to government waste, I think).

Triaging sounds distasteful, but I really do think that it will help enormously, especially in health care. The health care spending distribution, for example, is extremely skewed and concentrated: the top 5% of patients (in terms of the cost of their most health care expenses) spend almost 50% of the national health care money. The bottom 50% of patients spend 3% of the health care. A more detailed table and some interesting statistics appears here. I’m not saying that the distribution in and of itself is bad—it’s sort of inevitable, I think, particularly with the massive voting power of the elderly and just the way health care is structured—but the presence of such a skew would mean that if we focus on weeding out specifically the bad apples that appear at the very top of the distribution, that we could free up a substantial amount of money to help a larger number of people.

I recently read an interesting PLoS Biology article that covers the issues underlying intellectual property law as it would apply to synthetic biology, or the creation of new organisms and biological building blocks. It tries to address the balance between incentivizing products (such as drugs) by allowing for profit-making and some privatization and the need for openness and freedom to allow research and new innovation to happen.

Over the years, there have been lots of problems with the U.S. Patent system as it tries to keep up with the changing world. In this day and age, a lot of inventions are about ideas, information, and ways to organize such information. Software, algorithms, processes. The patent system wasn’t really designed to handle that kind of innovation, but rather the tangible kind, with physical products that would result.

Now, we have kind of a mess on our hands, and that’s starting to creep into biology. Can we patent the products of human genes? Is it legitimate to patent all diagnostics related to a particular gene? Derek Lowe often talks about patent issues with regards to the biotech and pharmaceutical industries, including the legitimacy of patenting recombinant genes as new chemical entities, and the finer distinctions in filing patents on genes and uses of genes.

For more on patenting genes and uses of genes, see this article from the Council for Responsible Genetics. One of the arguments against being able to patent the uses of genes is that it halts medicine via overly broad patents. Sure, using certain gene sequences to predict disease in a strict algorithm is patentable (and should be encouraged, to induce people to look for new, innovative ways of linking basic biology to medicine), but is using any natural gene for any diagnostic or research whatsoever patentable? That’s what Ariad did with NFkB, a gene that’s implicated in all sorts of biology. If the patent were actually enforced, research and drug development in immunology, inflammation, pain treatment, and so many other things would probably be crippled for the next 10 years. There needs to be some sort of balance, but where that should be struck is a hard question.

Since one of my friends sent me an email about this Nature newsletter, I thought I’d get my opinion out about Open Access Publishing.

Firstly, I like the idea of it. Part of the optimism of science is about the free flow of information, for the betterment of all. Open access publishing, in a sense, utilizes the great infrastructure of the internet to provide a free peer-reviewed (i.e. non Wikipedia-style) repository of the latest and greatest research coming from academic labs. Since much of the research is funded by the government and taxpayer-money, it would be nice (though not a moral obligation) to open the publishing to the public. Open access also allows for more collaboration, a wider dispersal of knowledge, and a lower barrier of entry for smaller research units (like private researchers, small colleges, and other individuals). In all sorts of ways, open access publishing might be a good thing.

I wouldn’t, however, want to require that all published materials funded by the government get opened to the public. Just because something is paid for by taxpayers doesn’t mean that it has to be opened to be public. The point of spending taxpayer money is to fund things that would have a benefit to the public, something that under normal market situations wouldn’t occur. Thus, things like building highways, the police and fire-department, funding hospitals, funding innovation via patents, and funding basic-science research via grants. None of these have any guarantees that the public can use them directly, since all that is a moral necessity is that the public somehow benefits from their continued funding and existence. Thus, toll highways allow for better trade and transportation, even though some people might not be able to afford to use them. The public, by default, can’t just use patented products, even though they (technically) pay for it by giving the owners monopolies.

In addition, the main point I want to talk about is that I don’t know how sustainable Open Access Publishing is. Publishers have continuing costs every year, from server costs to print costs, and not all of that can adequately be covered by the publishing fees that are charged to every author. These one-time fees eventually run out for each article, so the best way to cover their costs would probably be through advertisements, but online advertising is a tricky and fickle business, and I don’t know how I’d feel about the possibility of a journal going belly-up based on the rapidly fluctuating online market. This isn’t a precise analysis of any finances, and this is all pure speculation, but it’s just something I’m worried about (since I do happen to like the model very much). I’d like it to succeed, but we’ll have to wait and see if they stick around after 10 to 20 years.

What I don’t like, however, is that the old model of publishing is attacking the new, as described in the Nature article. I really dislike the ACS, as their journal qualities are declining as of late, with too much bloat and not enough content, and this is just the final straw. I would never subscribe to an ACS journal, as they just aren’t very interesting. I don’t like Elsevier, either, because their websites suck, they facilitate arms trading, and now they’re involved in this mud-slinging.

The two models should compete on the open playing field. If Open Access is unsustainable, it’ll collapse, eventually, and go back to the traditional publishing method. If the Open Access umbrella succeeds, then too bad, publishers, go on to your next job. I don’t have any pity for those who can’t learn new skills or transition; that’s why you get paid less, because you’re less valuable to others. If you’re losing subscribers because of Open Access, then give people more value for their subscriptions. Bundle online access, utilize your huge archives. Maybe make your journals that much better edited, or more carefully selected. Write more interesting highlight articles. Solicit more review articles. If you’re losing money to the free, what it means is that your journal isn’t worth anything more than free, and that means you’re doing a terrible job.