H&I* Fires, 7 DEC 2007

Ry...you sleeping on the couch? Look, there is a great concept out there that says that drug companies make medicine that makes you better. If its true, most people begin to trust the drug companies and assume that the drug company would not make anything harmful. Unfortunately, there is a tendency for drug companies in the "risk/benefit" ratio to assume that there is an acceptable "risk" of lack of pregnancy or birth defects for the benefit of improved skin, psychology, etc for the patient and profitability for them. Yes. They take a risk for profit. It's that idea that twists people's panties the most because they believe that drug companies, who have a huge reputation for performing miracles, play on that reputation, understanding that people will assume a company that most often saves lives, even if it puts out a risk warning label, is not intending to hurt someone or has lowered the risk factor considerably. The idea that the company then might turn around and make a profit based on a risk posed to others lives based on their selling a drug on their otherwise well earned reputation, sounds immoral. Kind of like the snake oil guy come to town. Not that I view them as such. I actually hold the same idea that most drugs are likely to change you in some way either physically or mentally when you take it. You are inducing a chemical, largely outside the normal body chemistry, into the blood stream. But, people don't want to believe it so its easy to blame the drug companies and insist they are immoral.

And the drugs are formulated and tested for a standard deviation or so from the median. Which, given the impact of genetics, means that people outlying from the median are going to be more and more likely to suffer the side effects. Or... am I missing something?

True, which means the risk is assumed to exist not at the creation of the drug, but at its prescription which would leave physicians in the same boat: risk/benefit ratio. Who assumes the risk and who pays for it if it goes wrong? I think that has a huge amount to do with mal-practice suits going up and insurance, thus cost increasing. People want risk free benefits. Not happening.

I need to applaud you all for posting about the new LA Times/Bloomberg poll that say among other things:

And among those families with soldiers, sailors and Marines who have served in Iraq or Afghanistan, 60% say that the war in Iraq was not worth the cost, the same result as all adults surveyed.

I often wonder what this means against the chorus of MilBlogs that claim to support the troops by specifically NOT substantively criticizing the president. It would seem to an objective observer, that given the great majority of serving troops and their families who say the war is not worth it, how can one claim to support the troops WITHOUT directly challenging the administration's myriad of reasons (and lies) for going to war and staying there. Really! I mean come on. I ponder this daily. How can any good American not stand up and scream - STOP THIS WAR NOW!

I feel your anger John, but let me suggest you will feel better when you direct it at the responsible ones. I've never suggested you shouldn't be allowed to vote but I would suggest such an idea is a freudian indication of your sense of guilt for voting for the guy. What I did suggest in my unanswered e-mail to you is that you may consider what you will tell your grandchildren when they ask you what YOU did when that criminal Bush tried to destroy the United States and the world. Don't take your stuff out on me brother. I'm just doing my duty as a real informed American. I have no regrets. How about you?

Well, my guess is that the family and the multiple deployments have an effect on this "support". Kind of the "long war" fatigue and it is likely not solely in regards to Iraq, but Afghanistan as well. There is plenty of evidence that shows how national fatigue translates to fatigue from the military. civil War, WWII, Vietnam (yes, Vietnam, don't think that everybody hated that war from the get go), etc, etc. What's interesting is that the poll was taken now when, for all intents and purposes, the war is going swimmingly and is about to conclude. Very likely that this results in a pressure release when the families start wondering, if that's true, when will their troops come home. And, of course, most of them haven't ever dealt with the VA so now that they are, it is considerably different and even more convoluted than active duty medical care. I'd be disappointed too.

John wrote: You believe me to be unethical in my worldview and actions, as you have made clear time and time again. I know you to be specifically unethical, and willing to do venal things in pursuit of your agenda, which you no doubt have tortuous justifications for. Cliff, you truly astonish me in your willingness to rely on others' restraint. But I suppose that is the way of bullies... they just keep pushing it until someone stands up to them. I suspect John will keep his own counsel on the details, but I would certainly be interested to see your response if he didn't.

when that criminal Bush tried to destroy the United States and the world. ummm... is it just me or is a tone of shrill desperation creeping into the voice of the "real informed Americans" Cliff speaks of/for?

Sorry to come back late on this, but, hey, I'm gollum and I sleep odd hours sometimes. So shoot me(no, that's not an offer to be a target, John). Nope, I don't sleep on the couch. She simply slaps when annoyed, and that's all this was for Jess. I'd have to do something incredibly stupid instead of just 1 degree away from 'the norm' stupid. And I honestly don't think this is stupid. Not when people at NIH are talking about 'nerfing the world' to end risk to pregnancies. Now *thats* stupid. 1) I find the argument about *why* pharma makes drugs to be a bit off. (I may not be the hoary old veteran of pharma like the Chief is with helofloppers, but I've actually worked in the industry while having quite a large number of friends who still do.) Wrong. Drugs get made because there's a demand, by the paying public, for them. PRofit comes into play with the pricing, and not the decision to make and the design of said drug(the design is based on what we can and can't do and biology). Risk to benefit is never something *we* were ever given. You, the public, comes to us chem nerds and say you have a problem you want fixed. We take a whack at it, and we tell you, point blank, that what we've got will do what you want so long as you accept these side affects. It's the public that damn well better know that they're supposed to be doing the cost:benefit thing. 2) Pharmacological affects are funny things. At some level the molecule in question is causing a change in something. Antibiotics work mostly on the microbial you're trying to kill. It causes changes within them. Unfortunately, sometimes, they also cause changes in the cells of the person. THe drug *acts* on something. Remember that. THis isn't freakin' magic and we don't live in Harry Potter world. It acts on something, it causes chemical/biochemical changes. A drug simply doesn't wander around your body only looking to act upon the one thing it's designed for. We often wish that it was. 3) It's been known for quite some time that the 'bible' on a given molecule takes a reeeeeeally long time to write. BUt the public won't wait on it. That want's it now, Precious. In the 90's there was a change in how FDA works---an Merck is the one's paying the price for the changes the public wanted Congress to make so they could get their drugs *right now*. The fast tracking of clinical trials is one of the largest travesties EVER. And it's the reason why I'm hesitant to buy into populism as inherently an un-alloyed good thing. 4) Prioritization. I had a specific set of scenarios in my head when Jess and I were discussing this, and some of that came across in this passage(simple convenience or vanity and then complain and when said drug, that they knew full well had risks associated with it while knowing they wanted to get pregers or that the way they lived their lives, created problems?). I was absolutely thinking of the women who a) wanted to get pregnant while they were on a drug that had the side affect(s) pertaining to fertility and fetal development; b) idiots who are on this stuff, going to bars, and partying like it's 1979(basically tremendously irresponsibly). What i would ask these individuals is this: what's more important to you? Having both is fundamentally un-available. Jeebus, we simply don't know how to make drugs without side affects(and I largely doubt that there is such a thing likely to be ever made). What's more important to you? Perfect skin and self image or the ability to have a healthy child/child at all? I didn't write the rules(might want to check with Unka Bill, he did give Sky Boss the recipe for mud. Maybe he was feeling devlish at the time.) and we simply have to deal with what is possible. It's impossible to have both. What's more important? ' 5) Yeah, Boss, you're missing something. There's no median. There's not really some nice gaussian we can deal with, maybe a non-nice statistical distribution but not a nice bell curve. That's why even dosages are a nightmare. You can have two men of equal height, weight, and same race who require notably different doses of X. It's largely dependent on what process you're mucking with. SOme processes are rather reliably the same from person to person, but many aren't. (Which is kind of why I wish the old pharmacist practice of binding their own pills/elixers in store would come back. A 5mg or 10mg pill doesn't quite cut it when you're an individual that needs 6mg but 10 mg is over-kill and causes the side affects for. Efficiency in production isn't always your friend. Just most of the time. My econ friends are probably on the warpath over that one.). 6) "True, which means the risk is assumed to exist not at the creation of the drug, but at its prescription which would leave physicians in the same boat: risk/benefit ratio. Who assumes the risk and who pays for it if it goes wrong?" No the risk for side affects is assumed to exist when the drug is designed(even aspirin has side affects, listed on the bottle and known from 150 some odd years of testing on it). We spend months(in the new chitty regime) or years trying to find them all. We're required to. Both ethically and legally, with the former being of greater importance. I've never met a pharma-chemist who didn't give a crap about how his molecule affected people. The person who assumes the risk for any given drug is the drug taker. It has to be you, and not the chemist. We've *told* you that the drugs have side affects. They all do, always. Everything has an ld50(lethal dosage for 50% of the population taking it, kinda like a c.e.p. for weaps for the staunchly mil-science). There's always something. Always. You're taking that risk when you take the med. Whether it be aspirin or cholesterol meds or vee-ageer--rrrra. Think about it. If the risk were on the pharmas they'd all be out of business since each and every time something happened they'd be financially responsible. What they are responsible for is making it in a manner that is as pure as possible(no CH3Cl occluded in the pill) and informing you of the dangers associated with the drug. We can't knowingly make something that is specifically lethal. Yes, there's no nice curve, metabolism being an odd thing, and people have nasty reactions to stuff. We know that's possible with each and every molecule on the market. You, the drug taker, are saying that despite these risks(always, always, always inherent) alleviation of your affliction is enough of a benefit to justify taking the risk. If you don't know that, well, then you're an idiot, though I feel bad saying that. If you don't know that you truly are an idiot about this. 7) " I think that has a huge amount to do with mal-practice suits going up and insurance, thus cost increasing. People want risk free benefits. Not happening." If I could kiss you, without you or Jess killing me, I would. That's so true, and is largely my point. 8) Acne was only the drug Jess brought up. It actually got started over some kind of bladder control drug commercial. And like I said, I had specific scenarios in mind. If you're married, want kids, and are taking this stuff? Damn it, you need to make up your mind which is more important to you. If conceiving naturally is something *really* important to you then you might not want to be on some of the meds out there(including, maybe, some of the different oral birth control meds. Maybe). Trias, yeah, I know acne can be real bad. Mark Springsteel was a guy I worked under who had really nasty acne scarring. BUt still, when he was thinking about getting married and having kids he stopped taking certain types of acne meds and moved to something that didn't work as well without the harmful side affects. Why can this dude do it, but every Britney on the block can't? Makes no sense to me, especially since it's law that every prescription leave a pharmacy with what amounts to a book on what the possible side affects and risks are. 9) "This could be your errant assumption. Errant in assuming that the acne treatment is perceived by the females as purely vanity as you perceive it to be." Sigh. Then someone needs to get real about the importance of 'radiant skin' in life, and it isn't me, loadr. We've evolved a long way from hunter gatherers, and not just socially either. New environment, new pressures, and therefor *new rules*. I often take this as a cop-out. It's utterly true, but people use it as a cop-out. Under this paradigm all guys should be hunting out hs girls or college girls. We know that doesn't happen anymore. We've even got a legal definition of men who want hs girls(pedophiles) which makes it outside the norm. Why don't we, you know, expect women to change in relation to the new environment too? (THe Wife gets the question, she's someone who has changed in relation to the new environment, but figures the rest of society just doesn't matter.). Oh, and Cliffy decided to come out and play. How nice.

Ry, I worked in a health food for years. I am leery of all meds, regardless of source. Bottom line, for most women who are wanting to conceive, if having a baby is really that important to them, they will discuss every teensy weensy detail with their doctor or nurse practioner to the nth degree. And when some get pregnant while taking a suspect drug, the second they find out, they will do one of several things: Stop taking the med until they get clearance from their doc, continue taking the med regardless or terminate the pregnancy. It depends on the woman, what she determines to be important. No politics need be involved... but if her SO is part of the decision making process, there might be other factors involved. For me it is black and white since I am not a chemist; I had horrible high blood pressure with each pregnancy and dealt with it using non invasive techniques like walking, drinking lots of water, and lying on my left side. I also ate a lot of fresh fruit and took a couple of prescription vitamins: B-15 and a thyroid supplement. I still don't know what the difference is between a glandular and what an endocrinologist would give, so there you have it. Acne was never an issue with me; when I was expecting, my skin cleared up even more. My hair was thick and shiny...but I gained a lot of weight. Hormones? I think so, despite walking a mile every day and watching what I eat. Sigh. Now, I have a question: I have been doing 'kitchen science' with my children using Dr. Jay Wile's books. I would love to get a decent chem set but they are so safe as to be a waste of time. HELP! Cliff, John is a good guy. I don't always agree with him, and he is one of those rare bloggers that will put up contrarian posts as long as the post or tone of the response is polite, reasonable and doesn't go into name calling and character assassination. We call that being adult. Cheerio.