Random charts - medical marketing

Source: Medical Marketing in the United States, 1997-2016 (JAMA)

Random charts - FDA

 

Source: Major shift ahead in how FDA regulates drug quality (5-pg PDF)

Radom pictures - mining

 

 

 

Source: De Re Metallica by Georgius Agricola (1556) - Project Gutenberg book. 

"... During 180 years it was not superseded as the text-book and guide to miners and metallurgists, for until Schlüter's great work on metallurgy in 1738 it had no equal. That it passed through some ten editions in three languages at a period when the printing of such a volume was no ordinary undertaking, is in itself sufficient evidence of the importance in which it was held, and is a record that no other volume upon the same subjects has equalled since. A large proportion of the technical data given by Agricola was either entirely new, or had not been given previously with sufficient detail and explanation to have enabled a worker in these arts himself to perform the operations without further guidance. Practically the whole of it must have been given from personal experience and observation, for the scant library at his service can be appreciated from his own Preface. Considering the part which the metallic arts have played in human history, the paucity of their literature down to Agricola's time is amazing. No doubt the arts were jealously guarded by their practitioners as a sort of stock-in-trade, and it is also probable that those who had knowledge were not usually of a literary turn of mind; and, [Pg iii]on the other hand, the small army of writers prior to his time were not much interested in the description of industrial pursuits..."

Random picture - MRI

Source: Helium Shortage Is No Laughing Matter

Update I - manufacturing

The December 19th, 2009 blog entry 'Drivel' took issue with the 'manufacturing in the U.S. is in complete decline' meme.

A recent (July 2014) CRS article, Measuring the Loss of Manufacturing Jobs,explains that manufacturing job loss data "... suggest that the United States is not an outlier when it comes to losing factory jobs...Over the entire period between 1991 and 2012, the most recent year for which comparative data are available, the United States shed 23.7% of its manufacturing jobs. This was a smaller percentage decline than that experienced by many peer economies, including France, Germany, Japan, the Netherlands, Sweden, and the United Kingdom..." 

However, the decline in manufacturing jobs does not translate into a decline in manufacturing. The article 'US manufacturing base is surprisingly strong' looks beyond the employment data and points out that:

"... the overall size of the US industrial base – real value-added in manufacturing – has been growing rapidly for more than four decades, and is on track to surpass the all-time 2006-7 high before the end of 2014..."

"...Real value-added in manufacturing grew by 3.1% per year over the entire period 1960-2007, and after a dip during the recession recovered with 4% per year growth from 2010 through 2013. Even with a growth rate no higher than 2.8% per year, the absolute size of the US industrial base – total value-added in manufacturing – will surpass the all-time 2006-2007 high before the end of 2014..."

and

"...  A careful look at the most recent and detailed data shows that despite falling employment, the US manufacturing base is growing larger, more productive, and more competitive."

Help on the way?

The March 30th blog entry, 'The why's of drug shortages', introduced the issue of drug shortages and provided some statistics re how bad the problem has become over the last few years. The issue has been polemicized, with many making arguments based on widely-different views, for example from 'Got Meds? Not Necessarily, Say U.S. Hospitals' ("deeper, more hidden reasons" responsible... implying malfeasance by manufacturers and suppliers) to 'Rx Drug Shortages: Regulation Can Be Deadly' (faulting excessive government regulatory intervention...).

Some of our worthy Senators pop up in the news every time a drug shortage occurs and hits the newspapers, a prime example being Senator Amy Klobuchar (D-Minnesota), see:

Klobuchar asks FDA for solution to chemo drug shortage
Klobuchar seeks to ease medication shortage
Klobuchar Addresses Medication Shortages
Klobuchar Urges FDA to Address Shortage of Shingles Vaccine

... and she has introduced legislation on the subject. S296, the 'Preserving Access to Life-Saving Medications Act'. A number of groups (the American Society of Anesthesiologists, American Society of Clinical Oncology, American Hospital Association, Institute for Safe Medication Practices, and the American Society of Health-System Pharmacists) also wrote a letter in support of S296.

So what does S296 do? It requires pharmaceutical manufacturers to notify the FDA six months in advance of planned interruptions, disruptions, or discontinuations of drug supplies; and as soon as possible following unplanned ones. The HHS Secretary is mandated to develop the reporting mechanisms and develop monetary penalties for reporting failures; as well as to identify which drugs might have shortages, in which case he/she then also needs to work with the manufacturers to "address" the shortages...

A good question to ask might be if this legislation actually addresses any of the multiple reasons that cause drug shortages... This blogger would argue that the answer is 'no'. While frustrating for practitioners to never know in advance what shortages are impending, the mere addition of possible earlier notifications to the current situation will prove of limited utility, and in many cases will exacerbate the problem (since the reflex action of any hospital's Pharmacy purchasing staff will be to 'advance buy' as much of the drug as possible before it goes on back-order!!)

Sens. Klobuchar, Casey Introduce Bill to Address Unprecedented Prescription Drug Shortage

S296 - ‘‘Preserving Access to Life-Saving Medications Act’’
ASA BRief summary: S.296 - Preserving Access to Life-Saving Medications Act

Misc update II

Picture credit: Flickr Factories

The September 26th, 2010 blog entry, 'Come on...', took issue with the meme that U.S. manufacturing is going down the tubes. A recent article, Made in the USA: US manufacturing still tops China’s by nearly 46 percent, provides data on the continued strength of U.S. manufacturing...

Quote: "... Americans make more “stuff’’ than any other nation on earth, and by a wide margin. According to the United Nations’ comprehensive database of international economic data, America’s manufacturing output in 2009 (expressed in constant 2005 dollars) was $2.15 trillion. That surpassed China’s output of $1.48 trillion by nearly 46 percent. China’s industries may be booming, but the United States still accounted for 20 percent of the world’s manufacturing output in 2009 — only a hair below its 1990 share of 21 percent.

“The decline, demise, and death of America’s manufacturing sector has been greatly exaggerated,’’ says economist Mark Perry, a visiting scholar at the American Enterprise Institute in Washington. “America still makes a ton of stuff, and we make more of it now than ever before in history.’’ In fact, Americans manufactured more goods in 2009 than the Japanese, Germans, British, and Italians — combined.

American manufacturing output hits a new high almost every year. US industries are powerhouses of production: Measured in constant dollars, America’s manufacturing output today is more than double what it was in the early 1970s..."

Come on...

Over the last couple of days have run across a number of articles in which various pieces of 'evidence' are adduced to support dubious conclusions. Correlation is taken as causality, complex situations are 'simplified' to one or two main issues and other, possibly confounding, factors are ignored, etc. Three examples:

• A. Following in the same vein as The Death of American Manufacturing (from 2006), and 'The Plight of American Manufacturing' (from December 2009), the article '19 Facts About The Deindustrialization Of America That Will Blow Your Mind' (September 2010) continues the meme that U.S. manufacturing is going down the tubes. This is mostly based on the facts that manufacturing accounts for a smaller share of GDP over time... and also the ongoing decline in manufacturing jobs. Both are taken as clear evidence that U.S. manufacturing is on its way down/out. Umm, not quite. Manufacturing as a percentage of GDP has declined for most of the industrialized countries, as it eventually will for the China and Indias of the world. However, U.S. manufacturing output and production continues to grow, its share of GDP has diminished because other sectors of the economy have grown faster. And manufacturing employment has decreased due to increases in productivity, and not because "jobs are being shipped abroad." (On a side note, manufacturing jobs have also decreased - for the same reasons, improved technology and productivity - in the countries to which U.S. jobs are "being shipped to." For example, while the U.S. lost approximately 11% of its manufacturing jobs over the last decade, the other manufacturing powerhouses have also lost manufacturing jobs - Japan 16%, Brazil 20%, China 15%, etc.). True, China will soon overtake the U.S. as the world's largest manufacturer, but that's hardly the same as the "weak manufacturing giant" characterization of the U.S.
  

The Future of Manufacturing, GM, and American Workers

• B. So How Did the Bush Tax Cuts Work Out for the Economy? looks at the Bush tax cuts. It starts out: "... The 2008 income tax data are now in, so we can assess the fulfillment of the Republican promise that tax cuts would produce widespread prosperity by looking at all the years of the George W. Bush presidency..." and then goes on to point out that over the Bush years "... Total income was $2.74 trillion less during the eight Bush years than if incomes had stayed at 2000 levels..." OK, so one could perhaps draw the conclusion that tax cuts did not stimulate the economy sufficient to cause growth. (Note: some might argue that this ignores a number of other factors and that absent these cuts things would have been worse - similar to the Obama "jobs created and saved" argument). However the article then goes on to strongly imply causality i.e. that the tax cuts actually caused the decrease in income. This is definitely a step too far, this blogger is unaware of any suggested economic mechanism or model that would argue this effect for tax cuts...
• C. '15 Shocking Facts Show That the Middle Class is Being Wiped Out' and 'The Middle Class in America Is Radically Shrinking. Here Are the Stats to Prove it' (both incidentally by the same author) purport to show that the middle class is "being wiped out." It doesn't particularly help that in neither does the author bother to define "middle class." The statistics quoted do go to show that there is much inequality in the U.S. (no surprise to anyone who has looked at its Gini coefficient, the highest among the industrialized G10 countries), and that the people at the two extremes of the spectrum are really hurting or doing extraordinarily well. However, the leap to the middle class "being wiped out" is not supported. It doesn't help that the reasons for this happening given in the two articles are that "... Both parties have absolutely refused to stand up to the Federal Reserve and the horrific economic policies that they have been shoving down our throats for decades..." and Ross Perot's "... giant sucking sound..." i.e. globalization and free trade. Ah, the yearning for easy answers, associated with the need to blame someone else!