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July 30, 2007

"A Great Article"

Matt writes:

This is, perhaps, the sign of a really great article -- a blogger can't write a good post about it.

I think that's more true than not. The best sort of article for blogging is smallish, with a clear point, and a singular outrage or insight you can engage with. A broad, wide-ranging, informative article that clearly knows more than you do is, by contrast, very hard to blog about. Matt mentions this in context of telling you, as Nick did, to read James Fallows "Why Americans Hate the Media." So do that. My most recent encounter with an article like this was Arnold Relman's overview of the pharmaceutical industry, which I highly recommend everyone spend some quality time with.

July 30, 2007 | Permalink



I was pretty unimpressed with the piece overall. Relman's bias and ignorance of key facts was actually pretty striking, a few examples:

- time-value of money is not a "theoretical and much disputed quantity," its a fundamental tenet to economics and day-to-day practice of business

- variability in response to drugs is well-accepted within the medical community. Racial differences in response to anti-hypertensive medications and gender differences in absorption rates for a number of drugs are two obvious examples.

- the infamous estimated cost of drug development of $800 million is based on development activities only, not research-- while he clearly thinks and states its both. Relman goes to explain academia's increasing role in research activities and suggests that the $800M figure is likely overstated as a result. As has been stated several times here, academia really only does research activities (~95% of the time), and then passes on to others to do development. An important error on one of the primary points Relman makes in the piece.

On the broader point, as to whether the industry is overregulated-- I think its hard to dispute this, in a relative sense. There are clearly other things in society besides pharmaceuticals that deserve the "special status" Relman discusses (which is reasonable)-- other parts of health care, food, housing, transportation. All of these other sectors bring new innovations to market frequently, and none are required to showed in a trial that they produce the statistically significant benefit they claim. This is not an argument for less regulation, but an acknowledgement of the situation at hand-- this is an industry that is one of the most regulated and others of similar importance are not. There would be tremendous benefit in greater regulation of the latter (think about safety of GMOs, health benefits/risks for processed foods/preservatives/fat types, safety of automobiles at different speeds/airbags/traction control, etc. there are a lot here). Yet for some reason, the focus remains almost exculsively on pharmaceuticals-- its hard to not see this as bias against an indutry that is extremely complex and profitable as a result, than a rational approach to indsutry oversight to do what's best for society.

Posted by: wisewon | Jul 30, 2007 12:48:02 PM

dr. relman's got a new book out, too...hasn't gotten much attention, but it's basically an expansion of the TNR article. maybe you could bring your keen critical eye to a review of it?

here's the website: http://www.tcf.org/list.asp?type=PB&pubid=613

Posted by: bukkah | Jul 30, 2007 1:24:32 PM

I find that to be true in general of longer pieces in The Atlantic and Harper's two magazines in particular that I enjoy reading. It's difficult to boil them down to even just a few paragraphs. When I do, I always feel as if there's more that should be included and that I'm doing the article a disservice. Sometimes I'll even resort to not quoting it at all, so I can just explain it my own words and talk about it.

Posted by: Xanthippas | Jul 31, 2007 12:02:04 PM

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