What I'm Reading (Aug. 17)

By Chuck Dinerstein, MD, MBA — Aug 17, 2023
To space and beyond A tale of statistics Are we part of Earth’s microbiome? The astronomical cost of drugs for rare orphan diseases
Image by amrothman from Pixabay

We seem to be headed back to the Moon, and if Elon Musk can take time away from Twitter, perhaps Mars. What might living in those places be like?

“We are a family whose earthly explorations will enable a better and inevitable future in space.” Rightly or wrongly, I don’t tend to be a joiner, and I’m skeptical of human space exploration’s scientific value and long-term likelihood. Cynic, realist, whatever: when I stood around chatting with my free drink, surrounded by optimism, I harbored some reservations about the usefulness of analog astronautics and the motivations of the participants.”

What is it like living in space? Recently NASA unveiled a project to look at living on Mars involving living in a Martian simulation for a year. We tried that experiment previously on Earth with Biosphere 2. From Scientific American, I Survived a Weekend at Biosphere 2 Pretending to Be in Space

 

“The B-17 was the most heavily used bomber in the U.S. war effort in Europe, dropping more ordnance than any other plane, but the losses were staggering. Fortunately, the damaged planes that returned provided a rich set of data for the air forces to study in the hopes of increasing survival rates. Reinforcing the entire plane against anti-aircraft fire would be infeasible—the added weight would reduce the range and cargo capacity too much. But perhaps parts of the planes could be reinforced. If the damage to the planes was random, there would be little benefit. But if the damage was systematic, affecting some parts more than others, then the army could fix the vulnerable sections, strengthen the planes, and possibly end the war sooner.”

A tale of practical statistical analysis. From Nautil.us, This WWII Story Made Us Better Thinkers

 

Sometimes changing our viewpoint and applying a different lens in the current parlance provides new and valuable insights.

“Large language models and image generators are enormous digestive systems that ingest and transform the raw materials of cultural output and behavioral data on behalf of voracious corporate interests. They suck down the sprawling detritus of human effort and swallow it into the great black box stomach of the AI system, which converts it into something uncanny and instant and profitable.”

What if all of nature was considered the Earth’s metabolism? From Wired, The World Is Toxic. Welcome to the Metabolic Era

 

“Gilead’s original proposed market price was $84,000. And from an economist point of view, that was a bargain. But the problem is, given the number of people that have Hepatitis C at the time, if every one of them had to pay $84,000, that would’ve easily blown the budgets of state Medicaid plans and many independent insurers that had to pay for these costs. And so the state of Louisiana developed an interesting approach. They agreed to pay Gilead a certain amount of money per member per month, and in exchange for that subscription fee, Gilead agreed to treat anybody and everybody in the state of Louisiana that needed the drug. It provides drug companies with cash flows immediately based upon the number of members and the per-member-per-month fee. And it provides the state of Louisiana with as much drug as they’ll ever need. And I think that that would apply very directly to rare diseases.”

While the price of insulin rightly gets significant consideration, orphan drugs are prohibitively expensive. And the rising use of biologics which routinely cost thousands of dollars annually per patient, is also putting pressure on health financing. From Freakonomics, Who Pays for Multimillion-Dollar Miracle Cures? You can read the transcript or, better yet, listen to the podcast.

Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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