A cancer drug’s new side effect is a thinning wallet

This recent Ars Technica article showcases a textbook example of the perils of mixing profit with medicine. While the headline of the article is a bit dramatic, the underlying storyline is clear-cut: Pharmaceutical company makes expensive cancer drug (Imbruvica, generic name ibrutinib, at $133 per 140 mg pill, with a dosage of 140 mg to 560 mg or one to four pills). Doctors experiment and find out that one pill instead of the typical three is usually enough for effective treatment, which is important because of the side effects. Pharmaceutical company changes manufacturing to four different dosages but prices them all at three times what the old pill cost, effectively tripling the price for those taking just one pill.

If this sounds outrageous, you’re not alone in that opinion by any means. To a lot of people, including doctors, patients, and others (its mention in places like the People For Internet Responsibility mailing list has helped raise the awareness of the issue), this looks like the companies, Janssen Biotech and Pharmacyclics, Inc., went for a quick cash grab, possibly after noticing that they weren’t selling enough pills at the already obscene original price.

This edition of Cancer Letter, a newsletter about cancer research and treatment, decries at length this absurd change made by the manufacturer. It is very technical, making it a bit difficult to understand if you aren’t a doctor or nurse. The part that’s pretty easy to understand, though, starts with this quote:

It is worth comparing the prescribing information for ibrutinib with that of warfarin, which has been called “the most dangerous drug in America”.[10] Warfarin is formulated in nine strengths ranging from 1-10 mg daily. However, prescribers have complete discretion to select the dose strength most appropriate for each individual patient, and may choose to prescribe a 2 mg strength for a patient whose daily dosage requirement ranges from 4-6 mg daily. Prescribers also choose to use every other day dosing on occasion. Needless to say, it would be not be possible to safely use warfarin if the prescriber had to order a new tablet strength for each and every dosage change.

In contrast to warfarin, we do not believe that physicians and patients will be able to prescribe and self-administer ibrutinib in accordance with the prescribing instructions without the ability to prescribe 140 mg tablets regardless of the daily dosage. When dose reductions are required and substitute tablets are not readily available, physicians will need to choose between continuing the higher dose (a major safety risk) or interruption of the dosing for as long as two weeks, which could potentially impact efficacy.[9]

But what do the manufacturers care? It’s all about the money; if they cure a few people of cancer, that’s all the good PR they need, and it’s better for the bottom line to take in $400 per pill regardless of dose than $133 per 140 mg pill, at least while it’s legal to do so.

The problem with this is that it says the drug itself costs only a knowledgable amount and what the patient (or actually, in the US, the patient’s insurance company) is paying for is the manufacturing. I know the cost of actually making the pills didn’t triple overnight. If the manufacturers have to do this just to cover their costs, then they are doing it wrong, but I really don’t think that’s the case.

The Cancer Letter goes on to urge the Food and Drug Administration (FDA) to review the change being made to how this drug is being priced. I’m surprised that the manufacturers were allowed to change the pricing like this without getting prior FDA approval. If a pharmaceutical company can hike the price like this on a whim, that’s a huge gaping hole in our prescription drug regulations that needs to be plugged stat. I’m not holding my breath, though, given who we have in both Congress and the White House.

The biggest etiquette blunder ever made by a US president?

A lot has been going on in the last couple of weeks, both in my life personally and in the news. My unintentional leave of absence could be said to be somewhat ill-timed, but the flip side of that was that the most prominent news story of the month, the Parkland, Florida, school shooting, has had plenty of time to develop. Oh, and develop it did. Next week, probably earlier rather than later, I may post about other aspects of the story. But for now, I’m going to focus on, as the title implies, a huge blunder made by the minority-elected “buffoon-in-chief” I refer to as DJT.

Among others, The New Civil Rights Movement covered this photo op that DJT went to in Florida, even though he wasn’t wanted. From the story:

Donald Trump left Washington D.C. on Friday to visit victims of the country’s latest mass shooting in Florida, although he wasn’t wanted, resulting in a new header photo for the president’s Twitter account.

Let’s step back a bit. Were this Barack Obama, or just about any other president in recent memory save for Richard Nixon, the reaction might have been different and at the least, the president’s presence would not have been specifically shunned even if not openly welcomed.

What I can read into this, though, is it’s quite likely DJT went down there mainly for the photo op. Damn the cost to the taxpayers, DJT’s got to feed his ego, right?

There are moments I’m proud to be an American. Seeing this weasel go and, er, weasel his way into Florida at the taxpayer’s expense, definitely is not one of them.

After the president told reporters that he saw some of those injured by a 19-year old gunman who killed 17 people and wounded 14 others on Wednesday, he praised doctors, law enforcement officials and first responders.

Trump subsequently ignored a reporter asking about the nation’s gun laws, but soon weighed in on his tone deaf visit via Twitter:

If you read the story linked above, it mentions that DJT didn’t mention any of the victims by name or age. Knowing what we know of DJT, it’s possible he made the whole thing up about talking to the victims. I wouldn’t put it past him. DJT is all about soaking up the good PR and feeding his ego, but when it actually comes down to doing the job of President of the United States, he folds like a poker player who knows he’s beat. It’s crazy. I know the personality. I’ve dealt with it before on a much smaller scale.

But let’s get back to that picture and the original story I linked to above. Of all things to do in this photo op, DJT decides to smile and do a thumbs-up gesture.

Fourteen kids and three adults are dead as a result of this violence. And DJT decides to do a thumbs up.

He gets asked a question about whether it’s time to change our nation’s gun laws. He dodges that question, so he can get to this photo op and do a thumbs up after seventeen innocent people lost their lives.

Those are the values of our Weasel-in-Chief. “Screw the country, this is all about me. Here’s a thumbs-up. I don’t care if seventeen people died and that it’s tacky to do this photo op with a thumbs-up like we’re opening a car dealership. I’m president, you’re not, so screw you.” It may as well have been a middle finger. That’s no doubt how at least some, if not most or all, of the surviving relatives are feeling about this thumbs-up if they found out about it.

These things together (the photo op, the thumbs-up, the whole “I look like I’m shooting a photo op for a used car lot opening” smile) all combine to show the intelligence and social grace of a very stupid worm. Not that it even matters due to the way we elected our president in 2016, but I’m so glad I didn’t vote for this bonehead. What is pictured in this photo is tasteless and disgusting. Actually, I take that back. It’s beyond tasteless and disgusting; it’s DJT’s biggest failure in etiquette as a president, possibly the biggest failure in etiquette ever by a sitting US president.

As repulsive as they may be, these photos need to be preserved. They should be preserved so we, the American people, know never to let this happen again: both an incident of violence such as the one that happened in Parkland, and the election by a minority of the worst excuse for a president this country has known at least since Richard Nixon, if not in its entire 240+ year existence.

Can we impeach him already, please?

Further thoughts on the Nolan Bushnell GDC award saga

Upside down Atari
So not too long after or perhaps even right before that previous post went live, the Game Developers Conference made the predictable, easy, and feel-good decision to rescind the Pioneer Award they planned to give to Nolan Bushnell. For reasons stated previously, I think this is the wrong move.

I’m going to go as far as to say that the GDC’s action to rescind Nolan’s award does far more to devalue it than proceeding with the original plan to present it to him ever would have. Apparently, now it’s acceptable to judge 1970s conduct by 2018 standards. This is grossly unfair to those who just “went with the flow.”

One post shared to the AtariAge group on Facebook, by way of a group called Classic Home Video Games, states “Sounds like he’s guilty of nothing more than partying, consensual/casual sex, and living in the swingin’ seventies.” This roughly aligns with how I feel.

Another post to the AtariAge group said, simply, “Nolan responds with class” and includes a link to Nolan’s official statement, posted to Twitter as an image, reads as follows:

I applaud the GDC for ensuring that their institution reflects what is right, specifically with regards to how people should be treated in the workplace. And if that means an award is the price I have to pay personally so the whole industry may be more aware and sensitive to these issues, I applaud that too. If my personal actions or the actions of anyone who ever worked with me offended or caused pain to anyone at our companies, then I apologize without reservation.

Maybe a lot of people see it as classy, but I am disappointed in Nolan’s response. The apology is understandable, but rolling over and saying in effect that it’s okay to go back and basically rewrite history is not. We know what acceptable conduct is in 2018. We know a lot of what went on in the 1970s and early 1980s would not fly by the standards we have here in 2018. I don’t see what’s so wrong with acknowledging that in the same breath as recognizing the good associated with the Atari and Chuck E. Cheese brands as the video gaming institutions that they are, by giving the founder the originally announced award.

There’s no nice way to say this: Nolan Bushnell got robbed, and the GDC really stepped in Bantha poop this year. I would go as far as to interpret Nolan’s statement as being made under duress, that that can’t possibly be what he really wanted to say, and the only reason we are reading what we are is he’s speaking out of fear of never getting this award. There’s really no other logical explanation for rolling over and saying it’s okay for the GDC to do this. Because it was not okay. A lot of the stuff that went on at Atari in the 1970s wasn’t okay either by today’s standards, but the reality is the same Atari where Nolan wore his “I love to fuck” T-shirt is the same one where all that magic happened.

I am not taking the side of sexual harassers of decades past, but instead, I am taking the side of fairness and decency, and recognizing the good achievements of someone even if there is some not-so-good mixed in with them. However, I am going to find it very difficult to recognize whoever gets the 2018 Pioneer Award in Nolan’s place to have received something that rightfully belongs to them, or to recognize the award at its full value. I can already tell you the very best case is that I’m going to be rather annoyed unless the GDC fully reverses course. At worst, my outrage knob is going to be turned up to eleven.

Here’s to hoping the GDC comes to its senses in 2019 and give the award to Nolan Bushnell as it was supposed to be this year. I’m hoping this #metoo stuff will have finally blown over by then.

(For those expecting my take on the State of the Union address, I have not forgotten about it; that will be addressed in a post no later than Friday. I have a huge backlog of draft posts to finish; hopefully, I’ll be caught up before Valentine’s Day.)

Nolan Bushnell versus the #metoo movement

Nolan Bushnell 2013.jpg

I grew up during the genesis of the video game industry. I had an Atari 2600, an Atari 1200XL computer, an Atari 7800, and an Atari Lynx growing up (I also had a Nintendo received as a holiday gift one year, which I requested once it became obvious the 7800 was lacking in decent titles). So I identify quite clearly as a member of the “Atari Generation” (not to be confused with the “Pepsi Generation”, as I mainly drank Coca-Cola and iced tea).

Fast forward to a few moments ago, when I found out from this article published in The Verge about how Nolan Bushnell, founder of Atari (and also Chuck E. Cheese, another 80s video gaming-related institution), was due to receive an award from the Game Developers Conference. Unfortunately, as you can see by the title of the article once you read it, this decision is not without controversy.

From the article:

In a 2011 interview, former Atari exec Ray Kassar recalls arriving on his first day in a suit, only to find Bushnell wearing a t-shirt that said ”I love to fuck.” In a Playboy profile from 2012, Bushnell wistfully recalls the “wild environment” of the ‘70s Atari era. “It was post–flower revolution, women’s liberation, no AIDS yet, and lots of company romances.” It also describes how the engineers at Atari code-named their projects after attractive female employees; “Darlene,” the code-name for the home version of Pong, was inspired by a woman who Bushnell described to Playboy as “stacked.”

And further down:

[Steven L. Kent’s book The Ultimate History of Video Games] also quotes Pong designer Al Alcon, who describes one such meeting. “Nolan needed some papers and documents so he called his office and said, ‘Have Miss so and so bring them up.’ We were in this tub [when she arrived], so he proceeded to try to get her in the tub during the board meeting. Nolan’s attorney was miffed [because] we got his papers wet. He was not in the hot tub and he was not amused by any any of this. That was the sort of fun we had.”

My stance on this is not cut-and-dried one way or the other. I support the #metoo movement in principle. Sexual harassment and sexual abuse is unacceptable conduct in decent society. We as a society have made great strides in this over the past quarter century or so. The portions of Nolan’s conduct which qualify as inappropriate in retrospect should be condemned. I consider such conduct indefensible, at least by today’s standards, and I’m not going to try to defend it.

However, I feel that denying Nolan the award by judging his 1970s and early 1980s conduct by 2018 norms is completely unfair. That’s how some guys acted back then. Obviously, that conduct would never fly in a corporate environment in the present day. The 1970s were a different time with a different set of cultural norms. It would be like discrediting Benjamin Franklin’s contributions to science and the founding of the United States just because he once wrote an essay entitled “Fart Proudly” which some might find distasteful. (Yes, I’ll admit my inner 10-year old giggles a bit when imaging the guy pictured on our $100 bill letting one rip. But I digress…)

Further down in the article, game developer and US House of Representatives candidate Brianna Wu is quoted as saying “Bushnell is an important figure. But this isn’t the year to honor him.” While I feel Brianna has a point, I have to look at it from the other side. Will we be ready next year to honor Nolan’s pioneering work in video games? Is it the intent of the #metoo movement to disqualify Nolan from getting such an award one year at a time until he dies, and possibly even after? That’s certainly what I see happening; this is the top of a potentially steep and very slippery slope.

I also have a feeling Atari wasn’t the only company in the industry where such things happened. If we’re going to say Nolan doesn’t deserve the award because of this, that too is the top of a potentially steep and very slippery slope. And the end result of it would be that a lot of people who made the video game industry what it is today will miss out on a lot of awards they otherwise would have received. I’d like to think that’s not really what the #metoo movement is after.

So in conclusion, despite the opposition, I think GDC is doing the right thing by giving Nolan the award they have announced. However, I would not be opposed to the GDC condemning the instances of Nolan’s inappropriate conduct from four decades ago. I also do not feel Nolan’s rather belated apology for that conduct would devalue the award itself, nor the presentation of the award to him today in 2018. Times change, and we should not throw the proverbial baby out with the bathwater just because of that.

Profanity and racism: an example of how not to lead

This has to stop somewhere and somehow. I know I haven’t been the most active in writing about this flimsy excuse for an administration, but this simply cannot be ignored. This post will have profanity in it, but only because I’m quoting our supposed “leader” here in the US.

Continue reading Profanity and racism: an example of how not to lead