Saturday, August 19, 2017

[ed. Oh, yeah...]

Aging Parents With Lots of Stuff, and Children Who Don’t Want It

Mothers and daughters talk about all kinds of things. But there is one conversation Susan Beauregard, 49, of Hampton, Conn., is reluctant to have with her 89-year-old mother, Anita Shear: What to do — eventually — with Mrs. Shear’s beloved set of Lenox china?

Ms. Beauregard said she never uses her own fine china, which she received as a wedding gift long ago. “I feel obligated to take my mom’s Lenox, but it’s just going to sit in the cupboard next to my stuff,” she said.

The only heirlooms she wants from her mother, who lives about an hour away, in the home where Ms. Beauregard was raised, are a few pictures and her mother’s wedding band and engagement ring, which she plans to pass along to her son.

So, in a quandary familiar to many adults who must soon dispose of the beloved stuff their parents would love them to inherit, Ms. Beauregard has to break it to her mother that she does not intend to keep the Hitchcock dining room set or the buffet full of matching Lenox dinnerware, saucers and gravy boats.

As baby boomers grow older, the volume of unwanted keepsakes and family heirlooms is poised to grow — along with the number of delicate conversations about what to do with them. According to a 2014 United States census report, more than 20 percent of America’s population will be 65 or older by 2030. As these waves of older adults start moving to smaller dwellings, assisted living facilities or retirement homes, they and their kin will have to part with household possessions that the heirs simply don’t want.

“We went from a 3,000-square-foot colonial with three floors to a single-story, 1,400-square-foot living space,” said Tena Bluhm, 76, formerly of Fairfax, Va. She and her 77-year-old husband, Ray Bluhm, moved this month to a retirement community in Lake Ridge, Va.

Before the move, their two adult children took a handful of items, including a new bed and a dining table and chairs. But Mrs. Bluhm could not interest them in “the china and the silver and the crystal,” her own generation’s hallmarks of a properly furnished, middle-class home.

The competitive accumulation of material goods, a cornerstone of the American dream, dates to the post-World War II economy, when returning veterans fled the cities to establish homes and status in the suburbs. Couples married when they were young, and wedding gifts were meant to be used — and treasured — for life.

“Americans spent to keep up with the Joneses, using their possessions to make the statement that they were not failing in their careers,” wrote Juliet B. Schor, the Boston College sociologist, in her 1998 book, “The Overspent American: Why We Want What We Don’t Need.”

But for a variety of social, cultural, and economic reasons, this is no longer the case. Today’s young adults tend to acquire household goods that they consider temporary or disposable, from online retailers or stores like Ikea and Target, instead of inheriting them from parents or grandparents.

This represents a significant shift in material culture, said Mary Kay Buysse, executive director of the National Association of Senior Move Managers, a professional organization of moving specialists who help older people downsize.

“This is the first time we’re seeing a kink in the chain of passing down mementos from one generation to another,” Ms. Buysse said in a telephone interview from the group’s headquarters in Hinsdale, Ill.

Accordingly, the senior move management industry has experienced unprecedented growth in recent years, Ms. Buysse said.

by Tom Verde, NY Times |  Read more:
Image: T.J. Kirkpatrick

'A Bit More'

Last year I fell in love with a toaster.

It looks like most others. A brushed, stainless-steel housing. Four slots, to accommodate the whole family’s bread-provisioning needs. It is alluring but modest, perched atop the counter on proud haunches.

But at a time when industry promises disruptive innovation, Breville, the Australian manufacturer of my toaster, offers something truly new and useful through humility rather than pride.

The mechanism that raises and lowers the bread from the chassis is motorized. After I press a button atop the frame, the basket silently lowers the bread into the device to become toast. On its own, this feature seems doomed to mechanical failure. But the risk is worthwhile to facilitate the toaster’s star ability: the “A Bit More” button. That modest attribute offers a lesson for design of all stripes—one that could make every designed object and experience better.

Toast is an imperfect art. Different breads brown at different rates. Even with the very same bread, similar toaster settings can produce varied results. When my bread doesn’t come up dark enough, I dial in a guess for another browning run. Usually I go overboard and burn the toast in the process. It’s toaster telephone game.

The “A Bit More” button enters here, at the friction point between good and great toast. When the toast reveals itself to me above the Breville’s chassis, I visually gauge its browness. If insufficient, I press the button, which actuates the basket motor. Down it goes for a brief, return visit to the coil. Then back up again, having been toasted, well, just a bit more.

The button also makes toasting bread, normally a quantitative act, more qualitative. The lever dials in numerical levels of browning, and the “A Bit More” button cuts it with you-know-what-I-mean ambiguity. That dance between numbers and feelings apologizes even for a slightly over-browned slice of toast by endearing the eater to the result the button helped produce.

Sure, I’m talking about toast. But Breville’s “A Bit More” Button is nothing short of brilliant. It highlights an obvious but still unseen problem with electric toasters, devices that have been around for more than a century. And then it solves that problem in an elegant way that is also delightful to use. It’s just the kind of solution that designers desperately hope to replicate, and users hope to discover in ordinary products. But agreeing on a method for accomplishing such achievements is harder.

The “A Bit More” Button was conceived by the industrial designer Keith Hensel, who worked for Sunbeam and then as Breville’s principal designer until his unexpected death in 2013, at the age of 47. His specialty was household products, like toasters, kettles, and blenders.

Breville’s head designer, Richard Hoare, tells me that Hensel, with whom he worked closely, fell upon the idea by “focusing on user empathy.” Hensel had been pondering the problem people have with toasters. “Your bread comes up too light, so you put it back down, then get distracted and forget, and it goes through a full cycle and burns,” Hoare relates. “Keith thought, why can’t the consumer have more control? Why can’t they have ‘A Bit More?’”

According to Hoare, the design team called the button by that name from the start. Some people within Breville thought it was too colloquial, and other options were considered. “Extra Darkness” was one, and “10% Extra” another. “These were confusing and clunky,” says Hoare. “In the end ‘A Bit More’ was the clearest.” Breville, which holds several patents in motorized toaster basket tech, started selling toasters with the feature in 2008. (...)

Hoare’s recollection corresponds with a trend in contemporary design practice—and one that claims to be particularly adept at producing outcomes like “A Bit More.” It’s called user-experience, or UX, design, a discipline that strives to craft pleasurable and useful encounters between people and things. Originally derived from human-computer interaction, or HCI, where user-interface design was its ancestor, UX purports to offer a general approach to design of all kinds, from software design to product design to architecture and urban planning.

But UX practice talks out of both sides of its mouth. On the one hand, UX fancies itself an empirical discipline. Its processes include ethnographic user research, specification drafting, iterative design, user testing, and so forth. UX inherits mid-century form-follows-function design ideals. It also embraces more recent trends, like participatory design, which deeply integrates stakeholders into the design process. Data are often incorporated into UX for affirming, denying, or directing elsewhere a design team’s attention.

On the other hand, UX design also privileges out-of-the-box genius to solve design problems. Apple, often considered to typify UX, is famous for conducting design in secret via a small cadre of geniuses. Steve Jobs is the ultimate example, a figure who held that “people don’t know what they want until you show it to them.” In the design-genius mentality, how a toaster (or smartphone, or building) ought to work becomes a type of soothsaying, whereby the designer earns the status of mastermind. Research becomes retrospective justification, the designer’s ingenuity validated by user adoption of the product—irrespective of how well it really serves their goals or interests.

Neither polarity of UX-style design really helps explain how one might best arrive at Breville’s “A Bit More” button. On one side is intuition. Keith Hensel, the genius who died too soon, possessed a sixth sense for taming the Maillard reaction and a congenial manner for proselytizing his solution. On the other side is evidence, via the research and participant observation conducted to cash out the “user empathy” Hoare cites as a compass bearing.

UX proponents tell tall tales about how good design really takes place. Bottom-up, evidentiary design implies that the designer is ultimately unnecessary, a mere facilitator who draws out a solution from the collective. The designer becomes a bureaucrat. And top-down, genius design becomes indistinguishable from salesmanship. As a result, design dissolves into other, more established disciplines like business intelligence, product marketing, and corporate evangelism. It’s an error that makes good design look far easier and more replicable than it really is. And worse, it allows people to conclude that their own expertise—from data analytics to advertising to illustration—is a sufficient stand-in for design. (...)

Allow me to indulge an analogy from philosophy. In both the genius and consensus registers, UX design predicates its success on knowledge: either the second sight of the designer, or the negotiated consensus of the user. Philosophers call the study of knowledge epistemology, and this approach to design is entirely epistemological. Just find the proper knowledge and the right design will emerge.

But when conducted best—including in Breville’s case, and despite Hoare’s insistence otherwise—design is more related to the philosophy of what things are, called ontology. It is a discipline of essence, that great bugbear of contemporary life, not of knowledge. Pursuing greater compatibility with a thing’s essence requires that the designer focus on the abstraction formed by the designed object and its human users together—whether it be toasting, dwelling, publishing, socializing, or anything else.

The designer’s job is not to please or comfort the user, but to make an object even more what it already is. Design is the stewardship of essence—not the pursuit of utility, or delight, or form. This is the orientation that produces solutions like the Breville “A Bit More” button. The design opportunities that would otherwise go unnoticed emerge not from what people know about or desire for toasting, but from deeply pursuing the nature of toasting itself.

by Ian Bogost, The Atlantic |  Read more:
Image: Breville

Mika Mäkinen, Dinosaur jr. - Gig poster project

Pornhub Is the Kinsey Report of Our Time

The streaming sex empire may have done more to expand the sexual dreamscape than Helen Gurley Brown, Masters and Johnson, or Sigmund Freud.

Waking up on a Sunday morning, I received a text about what happened after I left the previous night’s party. “Everyone got high and we played truth or dare. Ted and Ivan docked.”

“Are you serious?” I replied. “I thought that only happened in porn.” Defined by Urban Dictionary as “the act of placing the head of one’s penis inside the foreskin of another’s penis,” docking is an act that, until that fateful night, nobody at the party had attempted or witnessed firsthand. (Or so they claimed.) But once you know a thing is a thing, sometimes you can’t get it out of your mind. And in a fit of libidinous boredom, or idle curiosity, or lust, or who even knows why anyone does anything anyway — you do that thing. Because that thing exists, and so do you. At some point, someone had to.

On the internet, there is a maxim known as Rule 34, which states: If you can imagine it, there is porn of it. No exceptions. And now that we are solidly into the age of internet pornography, I believe we are ready for another maxim: If there is porn of it, people will try it. (Maybe we can call it Rule 35.) And if people are trying that thing, then inevitably some of them will make videos of that thing and upload those to the internet. The result: an infinitely iterating feedback loop of sexual trial and error. Once upon a time, someone would try something new on film and it would take years to circulate on VHS or DVD through a relatively small community of porn watchers. But today, even the mainstream is porn-literate, porn-saturated, and porn-conversant. For a sexual butterfly effect to take place, you don’t even need to try that thing with your body — you can watch it, text about it, post jokes about it on Tumblr, chat about it on Grindr, masturbate while thinking about it, and type its name into so many search engines as to alter the sexual universe. There is such a thing, now, as a sexual meme — erotic acts and fantasies that replicate and spread like wildfire.

For we are living in a golden age of sexual creativity — an erotic renaissance that is, I believe, unprecedented in human history. Today you can, in a matter of minutes, see more boners than the most orgiastic member of Caligula’s court would see in a lifetime. This is, in itself, enough to revolutionize sexual culture at every level. But seeing isn’t even the whole story — because each of us also has the ability to replicate, share, and reinvent everything we see. Taken as a whole, this vast trove of smut is the Kinsey Report of our time, shedding light on the multiplicity of erotic desires and sexual behaviors in our midst. (...)

As long as there has been porn, there have been people worrying that porn is damaging sex. I’m not here to join that debate. The deeper we go down the internet-porn wormhole, the more it seems narrow-minded to understand porn exclusively in terms of what kind of sex it “teaches” us to have. Because in the streaming era, the amount and diversity of porn we watch exponentially outpaces that of the sex we have. Porn is bigger than its real-sex analog, and the difference isn’t just volume: The porn we see is weirder, wilder, and more particular than what most of us will ever have — or want — in our own lives. An expansive erotic landscape unto itself, pornography exists adjacent to and in constant conversation with real sex — but is much more capricious and capacious and creative. Pornography is more than a mere causal agent in the way we screw. It has also become a laboratory of the sexual imagination — and as such, it offers insight into a collective sexual consciousness that is in a state of high-speed evolution.

The speed of that evolution may be best observed in the deluge of sexual memes that depart from traditional real-world sexual behavior. In addition to acts like pussy-slapping and ball-squeezing — which could theoretically be included in some crazily updated version of The Joy of Sex — the new generation of sexual memes includes a new set of narrative memes. Pornographic scene-setting, erotic situations, and role-playing are being reinvented, and imaginations have expanded to accommodate a never-ending supply of novel stimuli. Some of these memes seem to live almost entirely within the realm of porn. (Does anybody enjoy being searched by the TSA?) Some may have real-world origins, but have undergone so much reimagining as to approach derivative art. (When homemade-porn versions of the video game Overwatch spiked last year, had there been a preceding spike in dirty talk in the headsets of Overwatch players?) And others are only acceptable when they don’t have real-world analogs. “Is it me or is there way too much stepdaughter porn lately?” a straight man recently asked. He was right, and it doesn’t stop there: In the U.S. in 2015 and 2016, the most popular search term on Pornhub was “stepmom.” Though he said he was “immensely insulted” by the genre, that didn’t prevent him from watching. “If I ignore the title and the girl looks hot, I open it.” And no, “stepsister” porn has not made him feel any different about his sisters, and I can go to hell for asking. (...)

How users navigate that material in private — what they choose to watch, in what sequence and for how long — is a sexual-sociological gold mine. MindGeek’s understanding of its users’ autoerotic habits is almost terrifyingly precise. Like Facebook, Google, Netflix, and every other major player online, Pornhub collects and analyzes a staggering amount of user data — some of which it uses, like those other companies, to help curate content and determine what a user sees. Pornhub also publicizes some of its anonymized findings on the company’s data-analytics blog, Pornhub Insights. (Which means the X-rated version of Netflix is actually more casual with its data than the real Netflix. Knowledge of the human condition, in the age of big data, is idiosyncratic and subject to corporate marketing strategies.) To celebrate the website’s tenth anniversary, Pornhub Insights analyzed a decade’s worth of data — and provided access to that data, granting us an unusual peek into the internet’s collective id. And it’s an id that is constantly shape-shifting — sometimes very rapidly. New sexual memes are invented daily, and when they explode in popularity, they can spawn thousands of spinoffs and imitators. And sometimes they fade away just as quickly — another porn fad that came, conquered, and vanished. Overnight.

by Maureen O’Connor, The Cut | Read more:
Image: Ben Wiseman
[ed. See also: What We Learned About Sexual Desire From 10 Years of Pornhub User Data]

There Is More to Becoming an Elite Route Runner Than Meets the Eye

Save for the lucky few anointed as quarterbacks, every kid who picks up a football starts as a wide receiver. At their core, backyard games are a series of one-on-one clashes between pass catchers and defensive backs, and the first challenge any aspiring gridiron star faces is learning how to get open. No skill on a football field is more relatable. No goal is more familiar.

That shared experience is part of what makes route running at the highest level so misunderstood. On one level, the idea of beating the person across from you is among the simplest in football. But against NFL cornerbacks, creating space requires as much nuance and attention to detail as any undertaking in the sport. “It’s all about efficiency,” Packers wide receiver turned running back Ty Montgomery tells The Ringer. “I think you learn that through repetition. How many steps [are you] taking at the top? How [are you] getting off the line? How are you creating separation? What ways are you able to make the same route look different every time you run it?”

Route running is a skill that’s both oft-discussed and underappreciated, and it’s become increasingly coveted in an era when many prospects come from spread backgrounds and have less formal training in that respect than ever before. The question, then, is what distinguishes a novice route runner from an expert—and how improvement happens. I talked to some of the league’s best receiving coaches and route runners to find out what goes into a part of the game that’s far more complex than it sounds.

When practices begin each season, Bengals wide receivers coach James Urban starts at square one with his players. Whether he’s working with six-time Pro Bowler A.J. Green or rookie first-round draft pick John Ross, Urban teaches every one of his receivers how to line up in a proper stance, which involves positioning the outside foot forward in order to create an initial burst with the back leg. “We use those foundations so when something kicks up or something isn’t quite as clean as we want it to be or doesn’t look right or the timing’s not right, I can say, ‘Hey, fix your stance,’” Urban says. “And then they know what that means.”

Part of the goal is to create consistency among the receiving corps. Part of it is correcting the mistakes of players who have used the wrong get-off for years. Cardinals receivers coach Darryl Drake claims that making quick adjustments is especially crucial when it comes to young players. “It has to become a habit more than anything else,” Drake says. “And it takes a while when you’ve been doing it [wrong] for four or five years.”

From there, the next step is reinforcing the fundamentals: pushing off—and not dropping back—the outside foot at the snap, learning which foot to plant with on inside and outside cuts, and keeping one’s shoulders over the knees in order to stay balanced and give off the illusion of running a vertical route for as long as possible. These are the types of things that go unnoticed to the casual fan watching on TV, but serve as the building blocks for every receiver. And even for stalwarts like Packers star Jordy Nelson, there is room for small tweaks that can make a huge difference on the field.

When Green Bay wide receivers coach Luke Getsy arrived on the staff as a quality-control assistant in 2014, he introduced a new method for getting in and out of the break at the top of routes. By first planting on the inside foot—as opposed to the outside foot—when getting to the break of a route, the Packers receivers eliminated one small step and created a subtle but vital advantage. “By allowing us to get to that drop in [three steps] and letting our plant foot hit before or at the same time as the DB, we’re going to be successful no matter how good the DB is,” Nelson says. With 98 catches for 1,519 yards with 13 touchdowns, the 2014 season also happened to be the most productive of Nelson’s career.

For younger players, picking up on these types of tricks during film sessions and drills can mean transforming from an average route runner into a devastating one. During the early years of his career, Ravens running back Danny Woodhead had the privilege of playing alongside some of the best route runners at their respective positions that the game has ever seen: LaDainian Tomlinson, Antonio Gates, and Wes Welker. Each taught Woodhead something he’s carried with him for the rest of his career. “I’ve been fortunate because I’ve been able to play with some Hall of Famers,” Woodhead says. “It’s huge when you can watch someone who’s done it before, and not only done it before, but done it before at the highest, highest level.”

The mantra that Woodhead took from Welker was to try to make every route look identical until the last possible moment. These days, Woodhead will ask Baltimore’s linebackers if any slight lean or misstep gives away his routes during practice. For running backs, the goal when route running is to mimic the same release out of the backfield on every play. For receivers, the key is pushing vertically to make defenders think that they are streaking down the field each time they come off the ball. “That’s what scares a DB the most—[a wideout] going by him,” Rams wide receivers coach Eric Yarber says. “Something that’s going to strike up the band and get the fans going. That makes a DB tremble and poo-poo in his pants.”

Yarber says that the main weakness most young players have is a lack of patience. They lift their chests too early, tipping their hand and letting opposing cornerbacks know it’s time to slow down. Other young wideouts have a tendency to flail their arms to the side as they come to a halt—“the air brakes,” as Urban calls them.

Good route runners keep their bodies compact as they move up the field; the greats eliminate any possible indicator as to which direction they’re going. This obsession with deception has led some receivers to have coverage preferences that may seem counterintuitive at first brush. Cowboys slot receiver Cole Beasley says that while no receiver likes to be manhandled, he’ll take matching up with a tight press-coverage corner over trying to beat a defender who cedes a few yards of ground any day.

“I feel like from further off [from a defender], you have to be more precise with your movements,” Beasley says. “You could give something away easier because they’re looking at you from a further distance. They can see your whole body. But when you’re right there, there’s not much for their eyes to focus on.”

Learning how to master the mechanics is only part of the equation, though. To rise into the upper echelon, receivers must have not only a keen awareness of their technique; they also must develop a sense for what the defense is trying to accomplish.

by Robert Mays, The Ringer |  Read more:
Image: Getty Images/Ringer Illustration

Friday, August 18, 2017

Hooper's Law of Drug Development

We've come to expect technology to improve each year. Moore's Law is justifiably famous, with its remarkable ability to explain the past and predict the future. It states that the number of transistors squeezed onto integrated circuits doubles every two years; this pattern has held true for half a century. More transistors on chips allow computers to perform faster mathematical calculations.

Moore's Law is optimistic and reflects the ability of humans to "chip" away at a problem, making sequential, cumulative advances. Much of technology fits this pattern. One glaring exception, tragically, is the drug development conducted by pharmaceutical companies. It is hugely expensive and has gotten more so each year. If costs continue to grow at 7.5 percent per year, real costs will more than double every 10 years. The pharmaceutical industry seems to be operating under a reverse-Moore's Law. I call it Hooper's Law. Here's the short version: Drug development costs double every decade. Why? Simple: the U.S. Food and Drug Administration is steadily increasing the cost per clinical trial participant and the number of required participants per clinical trial.

Technology and Moore's Law

The Cray 1 supercomputer that I used at NASA in the early 1980s cost an inflation-adjusted $28 million. Today's iPhone 7, at a cost of $650, is equal to 2,000 Cray 1 supercomputers. Per dollar, the iPhone 7 performs 90 million times as many calculations as the Cray 1. And for that price, you get a phone too.

"The field of drug research and development seems immune to the powers that drive Moore's Law."

Why shouldn't drug research and development fit this pattern? Every year scientists learn more about biology, physiology, pharmacology, and the natural history of diseases. They study what has worked and what hasn't. Their tools become more precise and more powerful. And yet the field of drug research and development seems immune to the powers that drive Moore's Law.

Drug Development is Expensive

Each year, to launch a certain number of new medicines, companies plow more and more money into research and development. Joseph DiMasi, Henry Grabowski, and Ronald Hansen, in a study performed for the Tufts Center for the Study of Drug Development, have estimated that the cost of bringing a new drug to market, in 2013 dollars, is $2.558 billion ($2.69 billion in 2017 dollars).12 Further, as a condition for approval, the FDA often requires drug companies to conduct post-marketing clinical trials to answer some remaining questions. Those post-marketing studies add $312 million, on average, to a drug's cost, raising the overall price tag to $2.87 billion in 2013 dollars ($3.02 billion in 2017 dollars).

Why is this number so large? One reason is that much of R&D is spent on the roughly 95 percent of drugs that fail along the way. The 95 percent failure rate is an average; some drugs have a 50 percent chance of success and others have a 1 percent chance. It depends on the drug, the therapeutic area, and the stage of the drug's development. A 2014 study by researchers at Cleveland Clinic found that 99.6 percent of more than 400 Alzheimer's clinical trials had failed.3 The $2.558 billion tab accounts for those "dry holes." (...)

Reasons for Expensive Clinical Trials

Why have drugs become more expensive to develop? Some examples illustrate why.

When I worked at Merck in the early 1990s, one of its biggest drugs was Vasotec (enalapril). It was tested in 2,987 patients before FDA approval. Mevacor (lovastatin), another of Merck's big drugs at the time, was tested in 6,582 patients in the EXCEL Study. At the time, that was thought to be a massive trial.

Now the situation is different.

Orexigen Therapeutics was conducting clinical trials on the obesity compound Contrave (naltrexone/bupropion). In 2011, the FDA asked the company to conduct a trial on between 60,000 and 100,000 patients. This clinical trial would have been enormously expensive, especially considering the resources available for a small company like Orexigen. In response to this request, Orexigen discontinued the development of Contrave and all of its other obesity drugs.7 During this period, the firm's stock price dropped 70 percent, and Orexigen laid off 40 percent of its staff.

Later, after negotiations with the FDA, Orexigen eventually ran a clinical trial on fewer than 10,000 patients. While this reduced requirement enabled the trial to proceed, this was still a huge and hugely expensive clinical trial.

The REVEAL trial, in which Merck is currently testing the experimental drug anacetrapib, includes a whopping 30,000 subjects and is being conducted at 430 hospitals and clinics in the United Kingdom, North America, China, Germany, Italy, and Scandinavia.

Between 1999 and 2005, the average length of a clinical trial grew from 460 days to 780 days, while the number of procedures on each patient (e.g., blood draws, scans) grew similarly, from 96 to 158.8 Comparing the 2001-2005 period to the 2011-2015 period, one study found that the number of study participant visits to care providers (e.g., hospitals, clinics, doctors' offices) increased 23-29 percent; the number of distinct procedures increased 44-59 percent; the total number of procedures performed increased 53-70 percent; and the cost per study volunteer per visit increased 34-61 percent.9

The protocols for clinical trials—those written recipes for how patients are to be recruited, dosed, and evaluated—have become more complex, as well. Dr. Gerry Messerschmidt, chief medical officer at Precision Oncology, reports, "When I was writing protocols 20 years ago, they were one-third the size that they are now. The change has really been quite dramatic."10

Clinical trials are more expensive now because the cost per participant has increased at the same time that the number of participants has grown. Why? Again, the answer is the FDA. (...)

Pharmaceutical companies typically estimate the future expenses and revenues for each prospective drug, looking forward 20 years. In some cases I know of intimately, they hire consultants to estimate expenses, revenues, and probabilities of success at each phase of development. They use these data to compute the financial value of each pharmaceutical project and, if the expected value (probability-adjusted value) of the project is negative, the consultants recommend discontinuing development.

Many new medicines are discarded for reasons that have nothing to do with safety and efficacy. Consultants have, for example, where the prospects looked poor, suggested killing drugs for brain cancer, ovarian cancer, melanoma, hemophilia, and other important conditions.11 Even though millions of dollars may have already been spent, these consultants would never recommend that a company knowingly proceed on a path toward losing more money unless some other crucial non-financial objective was being achieved.

by Charles L. Hooper, Econlib |  Read more:
Image: uncredited

I Spent a Month Learning Guitar on the Internet and It Actually Worked

As the legend goes, the Sex Pistols's bass player, Sid Vicious, didn't know how to play his instrument. High on amphetamines, he stayed up one night picking along to a Ramones album on a beat-up Fender. The next day, he was no Jaco Pastorius—but in the same way I hold a guitar after spending a month using the online guitar-learning platform Fender Play, he had a much better grip on things. (Well, musically speaking...)

Since the phenomenon known as the online instructional exploded in the form of the massive online open course (MOOC), YouTube tutorials, and master classes, I've been wary of the "watch (a screen) and learn" approach. I'm a social learner, for one, so if a lesson doesn't have a clear narrative flow between what I'm hearing and what I'm seeing, I'll make different connections than the person explaining something wants me to. Production-wise, they leave a lot to be desired, causing my mind to wander, and unfortunately Aldous Huxley's fantasy of "sleep learning" only sort-of works. My biggest gripe, though, is that I learn by asking questions, and I'm hesitant to try any mass-education program that doesn't allow them, even—and often, especially—if that's due to a platform's own limitations.

But guitar-playing isn't quite the same as eschewing history to devote more time to computer science, and a revolving door of guitar teachers, from junior high to the present, left me with enough glaring gaps in my own understanding of my instrument that I feared I'd be stuck mangling cover songs until I could nail down a reliable network of fellow noobs.

So, armed with an American Professional Stratocaster (full disclosure: Fender sent one me to keep as a tool with which to do my review), I spent four weeks on my computer and smartphone, working my way through 67 individual lessons spread out over five difficulty levels, covering everything from basic picking through 12-bar blues and how-to guides to rock classics like Heart's "Barracuda." Unless you're training to out-fiddle the devil—which I wasn't—a typical guitar lesson lasts about an hour, once a week. This was 13.5 hours at home over the course of four weeks. And you know what? It worked.

Before you ask me to play "Eruption," however, allow me to qualify: I'm no Anna Calvi—hell, I'd be lucky to call myself a Johnny Depp—but what I am is, finally, equipped with the basic building blocks upon which I can grow and develop my own skills and style as a player. Here's why:

by Emerson Rosenthal, Creator |  Read more:
Image: Fender
[ed. I'm posting this just so people understand that it's not that difficult to learn guitar. But...!  Save yourself some bucks ($20/mo?!). Just go to these sites: Justin Guitar (or his Justin Guitar YouTube site), and Guitar Jamz (or its subset: Marty Music). And, if you're really adventurous: Tondr.

James McMurtry

The $70m High School Stadium

It cost over $70m and has 12,000 seats, multi-tiered stands, a $1.8m video screen and an exterior that lights up in the colours of the home team. None of which seems extraordinary in the gaudy world of Texas high school football.

What might be most striking about the state’s latest student sports palace is not the arena itself, but the wide-angle view encompassing what is next to it: another high school football stadium, neatly landscaped with a giant screen of its own and a capacity of almost 10,000.

The Texas high school building frenzy is often dubbed an arms race – in which case, Katy Independent school district (ISD), near Houston, is tooled up like few others.

Legacy Stadium, the latest most expensive high school venue in the nation, had its opening ceremony on Thursday night. The red-clad Tigers of Katy high school and other local teams will play there in the coming season. Rhodes Stadium, which opened in 1981, will still be used by the district’s sides – sometimes on the same day as Legacy, with kick-offs an hour apart.

These are heady times for Robert McSpadden, aka “Texas Bob”, a stadium aficionado who lives in Katy. That the fast-growing region needed another field is not in question, though whether it had to be so lavish is another matter.

“We had seven teams playing in one stadium, so we had Friday night lights and Thursday night lights, Saturday night lights and Saturday afternoon,” McSpadden said.

“More controversial than the cost, in my opinion, is building it right next to the other stadium. I think it’s ingenious. [At first] I did not like it at all – I thought, ‘That’s the dumbest thing I’ve ever heard of,’ but there’s so many shared resources.”

The city of Allen, near Dallas, ushered in this decade’s mega-stadium era with a $60m, 18,000-capacity venue that made national headlines when it opened in 2012, and then when it was embarrassingly forced to close temporarily in 2014 because of cracks in the concrete.

Another Dallas suburb, McKinney, is expected to complete a $70m, 12,000-capacity arena around the turn of the year. A third, Prosper, plans to open a $48m stadium complex in 2019. Alvin, 25 miles south of downtown Houston, will welcome a 10,000-capacity, $41m stadium next year. The city’s population is about 26,000.

It all makes the brand new place in the Austin suburb of Pflugerville – named The Pfield – seem a relative bargain at $25.8m for 10,000 seats.

There are 1,202 high school football stadiums used for regular-season varsity games in Texas, with a combined seating capacity of over 4.2m, and 17% of which have video scoreboards, according to, which says that a growing trend is to replace grass with artificial turf.

This works out to roughly one seat per seven Texans, or more seats than there are residents in 24 states and the District of Columbia.

Expenditure is not limited to stadiums. The Dallas Morning News last year found that Texas communities spent about $500m on 144 indoor practice facilities with artificial turf football fields over the past two decades – including two dozen that cost more than $5m in the Dallas-Fort Worth area alone.

by Tom Dart, The Guardian |  Read more:
Image: Tom Dart

Thursday, August 17, 2017

René Burri, Peace Hotel, Shanghai, China, 1989.

Public Enemy

From the jury selection process that took place over three days in June for the trial of Martin Shkreli, an investor and hedge fund founder who is facing eight counts of securities and wire fraud. In 2015, when Shkreli was CEO of Turing Pharmaceuticals, the company raised the price of its drug Daraprim by 5,000 percent. In 2016, Shkreli was widely criticized for defending the 400 percent increase in the price of EpiPen, an emergency allergy injection sold by Mylan. More than two hundred potential jurors were excused from the trial. Judge Kiyo Matsumoto presided. Benjamin Brafman is a lawyer representing Shkreli.

The Court: The purpose of jury selection is to ensure fairness and impartiality in this case. If you think that you could not be fair and impartial, it is your duty to tell me. All right. Juror Number 1.

Juror No. 1: I’m aware of the defendant and I hate him.

Benjamin Brafman: I’m sorry.

Juror No. 1: I think he’s a greedy little man.

The Court: Jurors are obligated to decide the case based only on the evidence. Do you agree?

Juror No. 1: I don’t know if I could. I wouldn’t want me on this jury.

The Court: Juror Number 1 is excused. Juror Number 18.

Juror No. 18: Both of my parents are on prescriptions that have gone up over the past few months, so much that they can’t afford their drugs. I have several friends who have H.I.V. or AIDS who, again, can’t afford the prescription drugs that they were able to afford.

The Court: These charges don’t concern drug pricing. Could you decide this case based only on the evidence—

Juror No. 18: No. No.

The Court: — presented at this trial and put aside anything you might have heard in the media?

Juror No. 18: No. No.

The Court: Sir, we are going to excuse you from this panel. Juror Number 25, come forward, please.

Juror No. 25: This is the price-gouging, right, of drugs?

The Court: This case has nothing to do with drugs.

Juror No. 25: My kids use those drugs.

The Court: As I said, the case does not concern anything that you might have read or heard about the pricing of certain pharmaceuticals.

Juror No. 25: It affects my opinion of him.

The Court: I am going to excuse you. Juror Number 40. Come on up, sir.

Juror No. 40: I’m taking prescription medication. I would be upset if it went up by a thousand percent. I saw the testimony on TV to Congress and I saw his face on the news last night. By the time I came in and sat down and he turned around, I felt immediately I was biased.

The Court: Sir, we are going to excuse you. Juror Number 47, please come up.

Juror No. 47: He’s the most hated man in America. In my opinion, he equates with Bernie Madoff with the drugs for pregnant women going from $15 to $750. My parents are in their eighties. They’re struggling to pay for their medication. My mother was telling me yesterday how my father’s cancer drug is $9,000 a month.

The Court: The case is going to come before you on evidence that you must consider fairly and with an open mind.

Juror No. 47: I would find that difficult.

The Court: And that’s based on your parents’ experience with medication?

Juror No. 47: It’s based on people working very hard for their money. He defrauded his company and his investors, and that’s not right.

The Court: Ma’am, we’re going to excuse you. Juror Number 52, how are you?

Juror No. 52: When I walked in here today I looked at him, and in my head, that’s a snake — not knowing who he was. I just walked in and looked right at him and that’s a snake.

Brafman: So much for the presumption of innocence.

The Court: We will excuse Juror Number 52. Juror Number 67?

Juror No. 67: The fact that he raised the price of that AIDS medication, like, such an amount of money disgusts me. I don’t think I’ll ever be able to forget that. Who does that, puts profit and self-interest ahead of anything else? So it’s not a far stretch that he could do what he’s accused of.

The Court: Please go to the jury room and tell them you have been excused. Juror Number 70.

Juror No. 70: I have total disdain for the man. When you go back to how he was able to put so many children —

The Court: You have negative feelings?

Juror No. 70: Very.

The Court: Would those feelings prevent you from being fair to both sides in this case?

Juror No. 70: I can be fair to one side but not the other.

The Court: We will excuse you from this jury. Juror Number 77.

Juror No. 77: From everything I’ve seen on the news, everything I’ve read, I believe the defendant is the face of corporate greed in America.

Brafman: We would object.

Juror No. 77: You’d have to convince me he was innocent rather than guilty.

The Court: I will excuse this juror. Hello, Juror Number 125.

Juror No. 125: I’ve read extensively about Martin’s shameful past and his ripping off sick people and it hits close to me. I have a mother with epilepsy, a grandmother with Alzheimer’s, and a brother with multiple sclerosis. I think somebody that’s dealt in those things deserves to go to jail.

The Court: Just to be clear, he’s not being charged with anything relating to the pricing of pharmaceuticals.

Juror No. 125: I understand that, but I already sense the man is guilty.

The Court: Well, I’m going to excuse you. Juror Number 144, tell us what you have heard.

Juror No. 144: I heard through the news of how the defendant changed the price of a pill by up-selling it. I heard he bought an album from the Wu-Tang Clan for a million dollars.

The Court: The question is, have you heard anything that would affect your ability to decide this case with an open mind. Can you do that?

Juror No. 144: I don’t think I can because he kind of looks like a dick.

by Harper's Magazine |  Read more:
Image: NBC/stevepb/MGN
[ed. Much easier to hate someone you can put a face on rather than a corporation. Same thing with Madoff. See also: Conservatives’ Blind Love For Corporate America Must End (from The American Conservative!)]

Flora Purim

The Greatest Good

Last winter, William MacAskill and his wife Amanda moved into a Union Square apartment that I was sharing with several friends in New York. At first, I knew nothing about Will except what I could glean from some brief encounters, like his shaggy blond hair and the approximation of a beard. He was extremely polite and devastatingly Scottish, trilling his “R”s so that in certain words, like crook or the name Brooke, the second consonant would vibrate with the clarity of a tiny engine.

MacAskill, I soon discovered, was a Cambridge-and Oxford-trained philosopher, and a steward of what’s known as effective altruism, a burgeoning movement that has been called "generosity for nerds." Effective altruism seeks to maximize the good from one's charitable donations and even from one’s career. It is munificence matched with math, or, as he once described it to me memorably, “injecting science into the sentimental issue of doing good in the world.”

Up to that point, I would have described my interest in charity as approximately average. I certainly hadn’t thought deeply about my donations long before I met MacAskill. I'd volunteered for music-education programs because I liked music, but this felt not like an exercise in selflessness, but rather an expression of my personal identity, like wearing clothes.

One night at an apartment party, MacAskill and I huddled with some beers in the corner of the kitchen to talk about his worldview, which he was turning into a book called Doing Good Better (out July 28.) Imagine you are a thoughtful 22-year-old college graduate who wants to make a great difference in the world, he said, invoking one of his many thought experiments. Many such people try to get a job with Oxfam, the Gates Foundation, or any number of excellent charities. That's fine. But if you don’t get that job at Oxfam, somebody just as smart and generous will get it instead. You’re probably not much better than that “next person up.” But imagine you go to work on Wall Street…

Wall Street? I probably interrupted.

Yes, imagine you work in investment banking. You make $100,000 and give away half to charity. The “next person up” would not have done the same, so you have created $50,000 of good that wouldn’t have otherwise existed. Even better, your donation could pay for one or two workers at Oxfam—or any effective cause you chose to donate to.

This story underlines an effective-altruist principle called “earning to give,” which is like tithing on steroids. Earning to give argues for maximizing the amount of money you can make and donating a large share of it to charity. What attracted me to the story wasn’t the specific advice (I have not yet sent a resume to Wall Street) but rather the philosophical approach to pursuing good in the world—counterintuitive, and yet deeply moral and logical. It was like pinpointing a secret corpus callosum connecting the right-brain interest in being a good person with a left-brain inclination to think dispassionately about goodness. (...)

The Scientific Method of Goodness: Effective Altruism

There are so many causes that focus on improving lives, and the spectrum is vast. Some worthy programs save lives (e.g. drug research to avert premature death), others alleviate suffering and poverty (e.g. by providing irrigation), and others focus on enrichment (e.g. by giving to a museum).

These programs exist along another wide spectrum, which is certainty. Some organizations distribute proven drugs (quite certain), others develop unproven drugs (less certain), and some lobby to reduce global carbon emissions (more uncertain). The point isn’t that the certain causes are better than less-certain causes, but rather that thoughtful donors weigh the risk that their donations won’t pay off, as they would any other investment.

When I decided that I wanted effective altruism to guide my decision, I called Will again to get a better understanding of the philosophy I was wading into. Then I spoke with several poverty experts and moral philosophers to learn why the movement might be misguided. I wanted to know it deeply, to see it closely, its virtues and its flaws.

The simplest way to explain effective altruism and its discontents is to begin with three pillars of the movement: (1) You can make a truly enormous difference in the world if you live in a rich country; (2) you can "do good better" by thinking scientifically rather than sentimentally; and (3) you can do good even better by trying to find the greatest need for the next marginal dollar. (...)

The Measuring of Life: GiveWell

When I asked several philosophers and poverty experts what causes they would give to, answers ranged from women’s rights to direct transfers to the poor. Iason Gabriel, a politics lecturer at Oxford University, made a surprisingly strong case for tax reform in the developing world. Africa, he said, loses tens of billions of dollars a year in illicit flows of money, even more than it receives in government aid. Helping governments crack down on tax avoidance could preserve billions in funds for the state to direct toward health and education. But I felt drawn to two personal values for my donation: I wanted to prevent premature deaths, and I wanted a high degree of scientific certainty that the money would be spent well.

The most common refrain from experts I consulted was that my priorities pointed in a clear direction: If what you want is to save lives with certainty, several people said, you have to go to GiveWell.

In 2006, Holden Karnofsky and Elie Hassenfeld were young Ivy-league-educated workers at a hedge fund, making more money than they needed, and searching for a worthy charitable cause. “We wanted the biggest bang for our buck,” Hassenfeld said, and since few outside organizations offered much guidance, they formed a club of several like-minded people to research a simple question: How did various charities spend money, and was there any evidence that they were doing good? “We were calling charities directly, but we weren’t always getting good answers,” he said. The gaping lack of hard data, combined with their personal mission to find that elusive greatest cause, inspired them to create GiveWell in 2007.

GiveWell is a meta-charity, an organization that evaluates other charities. They have four broad criteria, in Hassenfeld’s words: “effectiveness” (does the charity make a difference?), “cost-effectiveness” (how much difference does the charity make per dollar received?), “room for funding” (can the charity use your donation in the near future?), and “transparency” (is the charity forthcoming about its spending and its results?). Its top-ranked charities for this year include GiveDirectly, a radically simple approach to sending no-strings-attached cash to extremely poor households, and the Against Malaria Foundation, which distributes insecticide-treated malaria nets in sub-Saharan Africa. It’s impossible not to be struck by the encyclopedic thoughtfulness of GiveWell's analyses, which take months to complete and are often thousands of words long, contain more than 100 footnotes, and elaborate on concerns they have for even the top-ranked charities.

It is hard for the casual donor to determine on her own which charities do the most good. For example, compare two well-meaning organizations: Charity A accepts $100 and sends $90 to the field to buy better textbooks for Kenyan children. Charity B accepts $100 and sends $45 to the field to buy deworming tablets for Kenyan kids. If you focus on “overhead" costs, as many people do, the choice is clear: Charity A is twice as effective. But randomized controlled trials have shown that while textbooks do little to raise school attendance, medicine for intestinal worms often helps children go back to school. In the end, Charity B might be many times more effective. This is why it’s so important for organizations like GiveWell to track dollars and outcomes.

by Derek Thompson, The Atlantic |  Read more:
Image: HappyDancing / Mega Pixel / Shutterstock / The Atlantic
[ed. See also: How ‘effective altruism’ can save the world.]