Posts Tagged ‘innovation’
“I tell you, sir, the only safeguard of order and discipline in the modern world is a standardized worker with interchangeable parts.”*…
… a sentiment that grates on the indivisualists among us. Still, there’s no denying the enormous impact that standardization has had. In an excerpt from his book, Exactly: How Precision Engineers Created The Modern World, Simon Winchester on the revolution that came from interchangeable parts…
Lewis Mumford, the historian and philosopher of technology, was one of the earliest to recognize the major role played by the military in the advancement of technology, in the dissemination of precision-based standardization, in the making of innumerable copies of the same and usually deadly thing, all iterations of which must be identical to the tiniest measure, in nanometers or better. The stories that follow, in which standardization and precision-based manufacturing are shown to become crucial ambitions of armies on both sides of the Atlantic, serve both to confirm Mumford’s prescience and to underline the role that the military plays in the evolution of precision. The examples from the early days of the science are of course far from secret; those from today, and that might otherwise be described in full to illustrate today’s very much more precise and precision-obsessed world, are among the most secure and confidential topics of research on the planet — kept in permanent shadow, as the dark side necessarily has to be.
It was in the French capital in 1785 that the idea of producing interchangeable parts for guns was first properly realized, and the precision manufacturing processes that allowed for it were ordered to be first put into operation. Still, it is reasonable to ask why, if the process was dreamed up in 1785, was it not being applied to the American musketry in official use in 1814, twenty-nine years later? Men were running, battles were being lost, great cities were being burned — and in part because the army’s guns were not being made as they should have been made. There is an answer, and it is not a pretty one.
Two little-remembered Frenchmen got the honor of first introducing the system that, had it been implemented in time and implemented properly, would have given America the guns it should have had. The first, the less familiar of the pair, despite the evidently superior nature of his name, was Jean-Baptiste Vaquette de Gribeauval, a wellborn and amply connected figure who specialized in designing cannons for the French artillery. He supposedly came up with a scheme, in 1776, for boring out cannons using almost exactly the same technique that John Wilkinson had invented in England, that of moving a rotating drill into a solid cannon-size and cannon-shaped slug of iron. Wilkinson had patented his precisely similar system two years earlier, in 1774, but nonetheless, the French system, the système Gribeauval, as it came to be known for the next three decades, long dominated French artillery making. It gave the French armies access to a range of highly efficient and lightweight, but manifestly not entirely originally conceived, field pieces. (Gribeauval did employ what were called go and no-go gauges as a means of ensuring that cannonballs fitted properly inside his cannons, but this was hardly revolutionary engineering, and it had been around in principle for five centuries.)
The second figure, the man who did the most to bring the system of interchangeable parts to the making of guns, and whose technique was, unlike Gribeauval’s, unchallengeable, was Honoré Blanc. He was not a soldier but a gunsmith, and during his apprenticeship he became well aware of the Gribeauval system. He decided early in his career that he could bring a similar standardization to the flintlock musket, for the benefit of the man on the battlefield.
Yet there was a difference. A cannon was big and heavy and crude — a gunner simply touched his linstock, with its attached lighted match, to the vent, and the cannon fired — and so such parts as there were proved easily amenable to standardization. With the flintlock, however, the lock (that part of a musket that delivered the spark that exploded the priming powder that ignited the main charge and drove the ball down the barrel) was a fairly delicate and complex piece of engineering, made of many oddly shaped parts and liable to all kinds of failure. To the uninitiated, the names of the bits and pieces of a flintlock alone are bewildering: a lock has parts that are variously known as the bridle, the sear, the frizzen, the pan, and any number of springs and screws and bolts and plates as well as, of course, the spark-producing (when struck by the aforementioned metal frizzen) piece of flint. To render the lock into a standard piece of military equipment, with all its parts made exactly the same for each lock, was going to be a tall order.
Cost, rather than the well-being of the infantryman or the conduct of the battle, was the prime motive. The French government declared in the mid-1780s that the country’s gunsmiths were charging too much for their craftsmanship, and demanded they improve their manufacturing process or lower their prices. The smiths not unnaturally balked at the impertinence of the suggestion, and promptly tried selling their products to the new armories and gun makers across the Atlantic in America, a move that alarmed the French government, as it imagined it might well run out of weaponry as a result.
It was at this point that Honore Blanc entered the picture, taking a civilian job as the army’s quality-control inspector. His brother gunsmiths expressed their dismay over the fact that one of their number was going over to the other side, was a poacher turning gamekeeper. Blanc dismissed the criticism and got on with his job, his own motivation being the welfare of the soldier out in the field rather than allowing the government to cut costs. He was greatly influenced by M. de Gribeauval, and decided he could ape his system of standardization, ensuring that all the component parts of a flintlock he made as exact and faithful copies of one perfectly made master.
This master he made himself, carefully and with great precision, and with all the specifications laid down as precisely as possible (using the arcane system of the Ancien Régime, which still employed dimensional measures such as the pointe, the ligne, and the pouce) to tolerances of about what today we would recognize as 0.02 millimeters. He then made a series of jigs and gauges to ensure that all the locks made subsequently were faithful to this first perfect master, by the judicious use of files and such lathes as were available. The gunsmiths hired by Blanc to perform this task — by hand, still — made each lock exactly as the original. Providing that they did so, exactly, all the pieces would then fit perfectly together, and the whole assembled lock would fit equally perfectly into each completed weapon.
Yet only a small number of gunsmiths were willing to work under these stringent new conditions. Most balked. Making guns simply by copying parts reduced the value of the gunsmith’s craftsmanship to near insignificance, they argued. Unskilled drones could do their work instead. By arguing this, the French smiths were voicing much the same complaints as the Luddites had grumbled over in England: that precision was stripping their skills of worth. This argument would be heard many times in the future as the steady march of precision engineering advanced across Europe, the Americas, the world. The kind of mutinous sentiments heard in the English Midlands half a century before were now being muttered in northern France, as precision started to become an international phenomenon, its consequences rippling into the beyond.
Such was the hostility in France to Honoré Blanc, in fact, that the government had to offer him protection, and so sequestered him and his small but faithful crew of precision gun makers in the basement dungeons of the great Château de Vincennes, east of Paris. At the time, the great structure (much of it still standing, and much visited) was in use as a prison: Diderot had been incarcerated there, and the Marquis de Sade. In the relative peace of what would, within thirty years, become one of postrevolutionary France’s greatest arsenals, Blanc and his team worked away producing his locks, all of them supposedly identical. Blanc made all the necessary tools and jigs to help in his efforts — according to one source, hardening the metal pieces by burying them for weeks in the copious leavings of manure from the castle stables.
By July of 1785, Blanc was ready to offer a demonstration. He sent out invitations to the capital’s nabobs and military flag officers and to his still-hostile colleague gunsmiths, to show them what he had achieved. Many officials came, but few of the smiths, who were still seething. Yet one person of great future significance did present himself at the donjon’s fortified gates: the minister to France of the United States of America, Thomas Jefferson…
On the making of the modern world: interchangeable parts, from @simonwwriter, via the invaluable @delanceyplace.
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As we mix and match, we might spare a thought for another contibutor to our modern age, Jethro Tull; he died on this date in 1741. An agronomist who promoted planting seeds in rows (as opposed to “broadcast,” simply casting the seeds around), he perfected a horse-drawn seed drill in 1701 that economically sowed the seeds in three neat rows; because of its internal moving parts (including a rotary mechanism that became part of all sowing devices that followed), it has been called the first agricultural machinery. He later developed a horse-drawn hoe, a four-coultered plow that made vertical cuts in the soil before the plowshare.
Tull’s methods– horse-hoeing and row seeding, effectively a rejection of traditional Virgilian husbandry– were initailly controversial, but were steadily adopted by many landowners and helped to provide the basis for modern agriculture.
“Give credit where credit is due”*…
In the early 19th century, a young woman revolutionized the lumber business…
As a young woman, Tabitha Babbitt was a weaver in Harvard, Massachusetts. She used to watch the workers at the local sawmill. Observing them use the difficult two-man whipsaw, she noticed that half of their motion was wasted. It had two handles which two men would pull from side to side. However, the saw only cut the wood when it was being pulled forward. This meant the second or reverse pull was fairly useless other than to get the saw back to starting position which was a waste of energy. Tabitha proposed creating a round blade to increase efficiency. Eventually she came up with a prototype, attaching a circular blade to her spinning wheel, using the pedal of her wheel to power it. As the blade spun, no movement was wasted. The circular saw was connected to a water-powered machine to reduce the effort to cut lumber, meaning that wood could be cut faster with half the manpower. The first circular saw she allegedly made is in Albany, New York State USA. A larger version of her design was later installed in the sawmill.
But – Tabitha was a member of the Shakers, a Christian sect founded circa 1747 in England who had emigrated and settled in revolutionary colonial America. Their core beliefs centred round a perfect society, created through communal living, gender and racial equality, pacifism, confession of sin, celibacy and separation from the world. As such, they valued hard manual work, a simple lifestyle, and thrived on the forestry industry.
However, their beliefs prohibited any member applying for patents as they believed intellectual properties should be shared by the community with no restriction. Because she did not patent it (and according to wiki the reference to her invention exists only in Shaker lore), there is controversy over whether she was the first true inventor of the circular saw.
Two French men patented the circular saw in USA after reading about her saw in Shaker papers. One of the patentees, Stephen Miller argues she wasn’t the first inventor based on the date she joined the sect. He contended that it was invented at Mount Lebanon Shaker Village by Amos Bishop or Benjamin Bruce in 1793 – or not by a Shaker at all.
Samuel Miller obtained a patent in UK for a saw windmill which supposedly used a form of a circular saw in 1777 though the type of saw is only mentioned in passing, making it seem as though it was not his invention. Walter Taylor a few years later in same area of the United Kingdom seemed to have types of circular saws at his sawmill but in fact he only ever received patents for improvements to blockmaking.
However, it appears Babbitt’s circular saw design was much larger than other circular saw mechanisms and enough modifications were made to differentiate her invention from the rest. Her basic design was also the one that soon was copied at various American sawmills, popularising the use of circular saw in mills.
Tabitha was also credited with improving the spinning wheel head, inventing a process to manufacture false teeth, and inventing a process for manufacturing the then semi-revolutionary type of nail known as “cut nails” which replaced forged nails, a claim to fame she shares with a few other inventors including famed inventor Eli Whitney…
An unsung hero: “Tabitha Babbitt” from the Mills Archive, via Mathew Ingram‘s When the Going Gets Weird (also source of the image above).
* Attributed to Samuel Adams, who used the phrase in a late 18th century letter
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As we investigate innovation, we might recall that it was on this date in 1959 that Jack Kilby of Texas Instruments filed the first patent for an integrated circuit (U.S. Patent 3,138,743). In mid-1958, as a newly employed engineer at Texas Instruments, Kilby didn’t yet have the right to a summer vacation. So he spent the summer working on the problem in circuit design known as the “tyranny of numbers” (how to add more and more components, all soldered to all of the others, to improve performance). He finally came to the conclusion that manufacturing the circuit components en masse in a single piece of semiconductor material could provide a solution. On September 12, he presented his findings to the management: a piece of germanium with an oscilloscope attached. Kilby pressed a switch, and the oscilloscope showed a continuous sine wave– proving that his integrated circuit worked and thus that he had solved the problem.
Kilby is generally credited as co-inventor of the integrated circuit, along with Robert Noyce (who independently made a similar circuit a few months later). Kilby has been honored in many ways for his breakthrough, probably most augustly with the 2000 Nobel Prize in Physics.
“The sacred moon overhead / Has taken a new phase”*…
As Oliver Hawkins and Peggy Hollinger report, an analysis of commercial radio spectrum filings shows a growing number of players– government agencies, but increasingly private companies– bettting on the emergence of a lunar economy…
Private companies are staking claims to radio spectrum on the Moon with the aim of exploiting an emerging lunar economy, Financial Times research has found.
More than 50 applications have been filed with the International Telecommunication Union since 2010 to use spectrum, the invisible highway of electromagnetic waves that enable all wireless technology, on or from the Moon.
Last year the number of commercial filings to the global co-ordinating body for lunar spectrum outstripped those from space agencies and governments for the first time, according to FT research. The filings cover satellite systems as well as missions to land on the lunar surface.
“We will look back and see this as an important inflection point,” said Katherine Gizinski, chief executive of spectrum consultancy River Advisers, which has filed for lunar spectrum for three satellite systems on behalf of other companies since 2021.
Although total registrations were lower in 2024 than the previous year, the increased proportion of commercial filings reflects a race to build the infrastructure that will enable the “cislunar economy”, the area between the Earth and Moon…
More on the players and the game: “The race to claim the Moon’s airwaves” (gift article), from @financialtimes.com. See also:
* William Butler Yeats, “The Cat and the Moon”
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As we linger over the lunar, we might recall that it was on this date in 1971 that NASA accomplished the third lunar EVA: Commander Alan B. Shepard and Lunar Module pilot Edgar D. Mitchell became the fifth and sixth men to walk on the Moon (in the lunar highlands near the crater Fra Mauro) as part of the Apollo 14 mission.
During this four-hour “activity,” they deployed the Apollo Lunar Surface Experiments Package (ALSEP)– scientific experiments that were left on the lunar surface and other scientific and sample collection apparatus. B efore lifting off on the next day, the astronauts went on another moonwalk almost to the rim of nearby Cone crater, collecting 42.9 kg of samples along the traverse. At the end of this 3.45 km walk, Shepard used a contingency sampler with a Wilson 6-iron connected to the end to hit two golf balls.
“Some people worry that artificial intelligence will make us feel inferior, but then, anybody in his right mind should have an inferiority complex every time he looks at a flower”*…
Dan Davies took a ride in a silver machine…
A while ago, I was lucky enough to attend a presentation on a Google DeepMind project called “The Habermas Machine”. It’s a really intriguing use of the LLM technology – basically, you take a lot of people who disagree with each other and ask them what they think about an issue. Then you feed their answers into a model, which tries to produce a statement of minimal agreement that all of them might sign up to. They score the extent to which they do agree with it (which trains the model), and explain what it is that they don’t like about the statement. This second round allows the model to come up with another, better version, which also clarifies to the participants what the other side’s reasons are for disagreeing with them.
It’s called “The Habermas Machine” because it’s meant to, loosely speaking, do a similar job to Jurgen Habermas’ “Ideal Speech Environment,” In tests, there seems to be decent evidence that not only is the machine better than a human moderator at coming up with consensus statements, but that the machine-moderated process leads to more convergence of opinions among the actual participants. (I think I might have predicted this; the model obviously has a “flat” affect, and unlike a human being, isn’t always leaking clues from its intonation and body language about what it really thinks of the participants. That might suggest that as LLMs get better at simulating human responses, they might be worse for this purpose!)
There’s really a lot to say and think about this. But it’s Friday [as he wrote this] and I’m a facetious person, so instead I’m going to share the notes I’ve been making ever since seeing the presentation on which other philosophers and social theorists might also benefit from having machines made out of them.
The Giddens Machine – in accordance with the principle of double hermeneutics, it’s the Habermas Machine, but only for reaching agreement on interpretations of Habermas.
The Goffman Machine – after your side lost on the Habermas Machine, it comes along and generates a set of reasons why you shouldn’t feel so bad about that and should come back for another go.
The Bourdieu Machine – you type your views into it, and then it repeats them with slight and subtle adjustments to make you sound more middle class
The Fourcade/Healy Machine – it gives you a score, then makes you do the work of finding out how to change your views so as to increase your score. Finding equilibrium for the machine is your job now.
The Gambetta Machine – instead of finding a consensus, it selects the most awful version of each conflicting view, and then everyone switches to that in order to show how committed they are.
The Austin Machine – instead of telling the machine “I agree with this statement”, you have to tick a box saying “I hereby agree with this statement”.
The Grice Machine – like the Habermas one, but via conversational implicature it aims to create consensus among all the views that you haven’t expressed rather than the ones you have.
The Derrida Machine – everyone keeps asserting the same statements, but the AI brings them into agreement by changing the meaning of the words themselves.
The Crenshaw Machine – in each round the machine finds a new issue to divide up the group in a different way. Equilibrium is reached when everyone realises they’re on their own and need to get along with each other anyway…
A wry exploration of the possibilities of AI: “Fully automated social theory,” from @dsquareddigest.bsky.social
(Image above: source)
* Alan Kay
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As we delegate discourse, we might recall that it was on this date in 1981 that the first production model of the DeLorean sports car rolled off the assembly line at the Dunmurry factory, located a few miles from Belfast City Centre in Northern Ireland.
“For many Americans, the cost of one drug is the difference between life and death, dignity and dependence, hope and fear”*…
Longtime pharmaceutical executive Amal Naj laments the woeful state of the industry and calls for new leadership to win back public trust…
Some two decades ago, when I mentioned what I did for a living — manufacturing and marketing a wide range of prescription drugs — it elicited appreciative reactions from acquaintances. “I take your products every day,” a number of them would offer; others would mention how a specific medicine had made all the difference to their health and would ask whether a more advanced treatment was in the works; some simply marveled at the industry’s innovations as nothing less than miracles. Then there were some who teased: “Good business; you can charge whatever price.” I considered the quip an acknowledgment that lifesaving discoveries were worth the money. Pharma Man, they called me. It seemed to confer a certain respectability, of the sort reserved for a physician or a scientist or a teacher. There was a presumption in it, too, that I lived by certain ideals and ethics demanded of such an avocation. I was proud of being a Pharma Man.
Alas, I have now slipped precipitously in their eyes. I am seen as an avaricious man inexorably exploiting the misery of fellow human beings for profit — by inventing one new magic potion after another for which they cannot afford not to pay my price, because the only alternative would be pain and suffering, even death. My onetime champions have grudgingly tolerated this collective subjugation for years. But not anymore. Their festering anger has now broken into an open rebellion against the Pharma Man, the benevolent oppressor.
The recent murder of UnitedHealthCare CEO Brian Thompson in cold blood, a heinous and deplorable expression of this growing rebellion, cannot be condoned in any way. But the health care landscape is littered with provocations against the Pharma Man which play out daily on national television, in the newspapers, and on social media.
The Pharma Man’s reputation is only going to get worse as President-elect Donald Trump takes office and tries to fulfill his promise to bring down drug prices. And there is the specter of Robert F. Kennedy Jr. bringing his unconventional ideas to American health care in the new Trump administration; he has already publicly called for capping drug prices. Ironically, it had been the Democrats who made the industry — a financial hotbed of Republican support — a whipping boy in blaming America’s failure to deliver affordable health care to its citizens. But Mr. Trump has outshouted them all. He famously declared that pharma companies were “getting away with murder” and singled out Pfizer Inc. and publicly shamed the company and forced the CEO to roll back planned price increases.
As I watched Mr. Trump tower over the CEO at a White House appearance and later triumphantly declare the result of his disciplinary action, I was reminded of my school days when the headmaster would hoist a student by the collar to make the truant admit culpability in front of the class. It was humiliating for the Pharma Man, for I once worked at the company, proud of its pioneering history and its roster of some of the world’s most impactful medicines, a company that would go on to save millions of lives with its Covid-19 vaccine during the pandemic.
But the Pharma Man has earned this new reputation, and then some…
[Naj recounts (some of) the industry practices that have contributed to its fall from grace– familiar, but still striking…]
… It is baffling to me that we as an industry haven’t stepped out in front of the groundswell of national outrage and undertaken systemic changes to our business practices. We continue to conduct our business on the strength of our power over our customers, a power we derive from our possession of the inventions that prevent and treat and cure and which our customers cannot do without. That’s like possessing Tolkien’s One Ring, which gives the possessor unassailable power to rule over and dominate others. We set the price we want. We can cast our spell on doctors to prescribe our medicine and do our bidding. We can banish competitors who attempt to lay claim to our Ring of Power. We have institutionalized this leverage in our business, all the way from drug discovery and development to marketing and sales and distribution. This underpinning of the industry’s colossal machinery is rigged against the patient. No one in the leadership of the pharma industry has raised a voice, let alone stepped up to act, to alter this unfair state endured by their very own customers; it seems there are no hobbits in the industry ready to undertake the treacherous journey to Mount Doom in a quest to destroy the Ring.
We refuse to see how our customers see our business. In their minds, we owe our existence to their misfortunes and mishaps: the unexpected cancer, the heart that suddenly fails, the pancreas that fails to produce enough insulin. Our customers turn to us to help them deal with these events of life and living. Although they know it takes a lot of money and time to come up with a treatment, they also expect the pharma company to make it available to them at an affordable price. After all, they argue, axiomatically, the drug was specifically developed to serve their need, brought on by their unfortunate luck.
They volunteer in tens of thousands, sick and healthy, for a new drug to be tested on them so the company can prove it works and is safe; some can die from the potential side effects. They are the ones who help create the market for the drug. And to dangle it in front of them but out of their reach by charging unaffordable prices is unconscionable. It is hard to argue against that view: the symbiotic existence between our enterprise and our customers imposes a business — not to mention a moral — obligation on us to make the drug affordable to the patient who was instrumental in the development of the treatment in the first place. We also should not ignore the fact that the U.S. government helps out drug development with taxpayer dollars.
Unfortunately, our customers cannot rely on market forces for what the pharma companies won’t offer: a fair deal. Car companies, with their zillion features, battle among themselves to win over customers, and any and all of their cars, irrespective of their features, deliver the same result: transporting the buyer from one place to another. One can purchase any smartphone on the market and it will make the call, send messages, browse the web. But when it comes to drugs, the consumer doesn’t necessarily have alternative choices.
Take, for instance, the cholesterol-lowering drugs, known as statins. Among the seven or so statins developed so far, the most prescribed ones are atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor). Each statin has its own distinct efficacy and side effects, even though they all lower cholesterol. Physicians prescribe one statin or another based on patient condition and the desired outcome. In effect, the market of cholesterol-lowering agents gets divided into distinct segments of therapy, each offering just one single statin. Within each segment there is no competition to speak of (until the patent expires, allowing the entry of copies of the product, the so-called generics). Although the manufacturers compete with their sales and marketing campaigns to recruit patients to their respective statins, this sort of “competition” doesn’t significantly influence the price, as each product is viewed as distinct and un-substitutable, something that the manufacturers take pains to establish with their scientific papers and promotional materials.
We are known to shamelessly exploit these monopolistic powers. When we lose a patent on a drug, we pay off competitors to keep them from entering the market. (The Federal Trade Commission estimates that these anticompetitive tactics cost consumers and taxpayers $3.5 billion in higher drug costs every year.) Most commonly, we tend to extend patents with minor variations on the original drug, such as a new coating or a slight change in the formulation — this is called evergreening — which offer little or no additional benefits to the patient. (Some 78 percent of the patented drugs marketed between 2005 and 2015 are not new drugs, according to a study published in the Journal of the Law and the Biosciences in December 2018.)…
… A large truth is that our drug pricing is heavily influenced by our single-minded obsession with keeping our shareholders — not patients — happy. This is not unique to the pharma industry; delivering “shareholder value,” the appreciation of the company’s stock price, is an operational mantra of corporations across industries. Whatever earnest exercise a pharma company goes through to set drug prices based on R&D, manufacturing, marketing, and other costs, at the end of the day this is all swept aside by the pressures to achieve quarterly and annual sales and profit targets. Executives’ bonuses are tied to achieving these performance metrics, and their stock grants and options deliver additional riches when the company’s stock appreciates.
The pressures to serve the shareholder have only intensified in the past decade as the health care industry has become a sought-after vehicle for investors for the safe and steady and stellar returns it offers. Pharmaceuticals’ net profit margins are in the range of 15 to 20 percent, compared to 4 to 9 percent for large non-drug companies. A single successful drug can generate billions of dollars in sales, some as much as $15 billion or more annually. Many of our single pills, if incorporated into a company, would rank among the Fortune 500 companies.
Investors bet on our drugs long before they reach the market. They pore over scientific papers and decipher results of early-stage clinical trials of a drug with the zeal of a geologist prospecting for oil. They swarm medical and scientific conferences where the latest findings and opinions about a drug’s progress are presented. Living up to their expectations or, better yet, exceeding them becomes a high priority for companies setting their future financial performance targets. The patient is nowhere in the picture; few in executive suites agonize over whether to lower a price by 10 or 15 percent so many more patients can afford the drug.
The concept of affordability is not an operational imperative in the business, largely because top executives rarely interact with customers — the patients — to be sensitized to their needs, their plight really. In the car and smartphone industries, senior executives go around shaking hands with their customers and host regular conventions to take the pulse of their customers’ desires. In pharmaceuticals, a typical CEO’s calendar is filled with meetings with Wall Street analysts and fund managers, and the job of interacting with the customer is left to prescribing physicians, whom sales reps regularly badger with sales pitches.
But these prescribers we rely on to do our bidding with patients have lost public trust. The opioid crisis exposed a large number of doctors accepting bribes, as much as $100,000 a year, and sexual services to push sales. Although this is the most publicized example of corruption among doctors, there are many others that haven’t drawn much public attention. Nearly all Big Pharma companies have paid fines, some multiple times, to settle charges of bribing doctors. In 2013, Johnson & Johnson agreed to pay more than $2.2 billion in fines to settle charges that it had improperly promoted an antipsychotic drug; the government alleged that the company had paid “speaker fees to doctors to influence them to write prescriptions” and that its sales representatives “told these doctors that if they wanted to receive payments for speaking, they needed to increase” their prescriptions of the drug…
… n the pharmaceutical industry, influence peddling goes much deeper, to the very core of its business — the research and development — unlike in any other industry. Companies recruit leading researchers and academics to guide them during drug development, and to publicly pronounce their expert opinions in medical journals once the drug is successfully launched to the public. As critical as this alliance is to the successful development of a drug, it is now widely questioned because of these influencers’ financial ties to pharmaceutical companies.
ProPublica, a non-profit investigative journalism organization, has exposed several leading researchers and academics for accepting money from pharmaceutical companies which they didn’t disclose — or did so falsely — in connection with the scientific articles they published, some in prestigious journals like the New England Journal of Medicine and The Lancet. Among the prominent researchers ProPublica cited was the chief medical officer of Memorial Sloan Kettering Cancer Center, the nation’s leading cancer institute; he bullishly pitched to the investment community a new cancer treatment being developed by Roche without disclosing his financial ties to the company… If you want to find out if your doctor is receiving any money — how much and for what — from a company whose drug he or she is prescribing to you, you can go to the website Dollars for Docs and type in the name of the doctor. The site is the brainchild of ProPublica. It brings to mind the comparison with the U.S. Justice Department’s National Sex Offender Registry for the identity and location of known sex offenders.
In a world where doctors and researchers and medical academics all work as an army of influencers, the patient exists only as the customer to be influenced. It is a most peculiar aspect of our industry that we market our products to doctors (who help generate sales for us but don’t pay for the products) and we sell to our actual customers, the patients (who pay but have no control over the price they pay). Who decides the price? A very small group of wholesalers called pharmacy benefits managers (PBMs), owned by large insurers — CVS Health (which owns Aetna), Cigna, Humana, and UnitedHealthCare — that have been accused of padding their own profits at the cost of the patients they insure. These middlemen buy drugs on behalf of government and private employers and insurance companies. They negotiate prices with the pharma companies.
It may sound bewildering that the customers who pay for the drugs cannot negotiate directly with the manufacturers, unlike in the rest of the world. Even Medicare, the country’s largest health plan, covering 60 million Americans, can’t. In effect, the market forces of supply and demand — the backbone of all other commerce in America — are shielded from each other by the opaque wall of the middlemen. Imagine if the price of your car or a smartphone were negotiated by a handful of middlemen and you had no choice but to pay.
Today, 44 percent of Americans are either uninsured or underinsured; a 2021 national survey estimated that 46 million people couldn’t afford quality health care. Such news fails to register as profoundly worrisome in the psyches of pharmaceutical executives, largely because they are shielded from the customer by the systemic structure of the industry. Reports in the morning papers of patients unable to buy a lifesaving drug — like the news of Americans with diabetes struggling to procure high-priced insulin — might as well be the day’s weather report to them. Stories of struggles from further afield, like distant corners of Asia and Africa, where patients die because they can’t afford a blood pressure or cancer medicine, have even less of a chance of stirring the collective conscience of the industry.
I am often asked if I think drug prices are high, in the sense that they are unreasonable and exploitative. I’ve had difficulty answering the question in the past with a definitive yes or no, because many of the drugs have had such a profound impact in banishing diseases and prolonging healthy life. Their discovery didn’t come easy. I would respond that the prices reflected the cost of innovation, but that they could be lower. That conditional justification is harder to make these days.
More than 80 percent of the prescription drugs sold in the U.S. are generics, copies of patent-expired drugs. As copies, they have very low development costs. Their main costs lie in raw materials and manufacturing. And that cost is a fraction of the price the consumer currently pays for generics. I should know, because I manufacture many of them. For instance, a box of 30 five-milligram tablets of amlodipine, one of the most prescribed blood pressure medications, costs less than 30 cents to manufacture, and retails for $7 to $8.90 online and in U.S. drugstores, ostensibly discounted from $20 to $30. Simvastatin, a commonly prescribed cholesterol-lowering medication, costs less than 40 cents for a pack of 30 20-mg tablets; it sells at $7.87 to $22.28, discounted from $12 to $30. Even after adding the cost of marketing and distribution, the selling prices of these drugs are astronomical.
The consulting firm Pharmacy Benefit Consultants, which provides prescription coverage services to private and government employers, says the average wholesale prices — before the drug is sold to the patient — have been rising at “shocking rates.” Between the beginning of 2017 and March of 2018, it reports, the average wholesale prices of 450 drugs increased by between 25 and 100 percent. They included sharp increases for branded drugs that lost patents many years ago, such as 19.8 to 31 percent for Zoloft, which lost its patent in 2006, and 31.1 percent for Lipitor, which lost its patent in 2011…
… That is pathetic. Because the genesis of the modern pharma industry is anchored on the idea of delivering medicine at affordable costs. Inventors of insulin and antibiotics — the two most seminal discoveries in pharmaceuticals — refused to patent their inventions so everyone would have access to these lifesaving drugs at low costs. That mission seems not to have inspired the modern-day leaders in the slightest…
It is time for us to step up and make ourselves accountable to our customers, or else it will inevitably be done for us…
An insider calls foul: “The Pharma Man’s Negative Reputation is Fair,” from @rollingstone.com.web.brid.gy. Eminently worth reading in full.
Apposite: How the intent of a prescription drug program meant for the needy has been perverted: “How a Company Makes Millions Off a Hospital Program Meant to Help the Poor” (gift article)
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As we heal the healers, we might send healthy birthday greetings to Charles Value Chapin; he was born on this date in 1856. A physician and epidemiologist, he was a pioneer in American public health. He co-founded in first bacteriological laboratory in the U.S. (in 1888) in Providence, were he was Superintendent of Health– a position he held for 48 years. In 1910, he established Providence City Hospital where infectious disease carriers could be isolated under aseptic nursing conditions; his success inspired similar health control measures throughout the U.S. A professor (at Brown) and prolific writer, his impact on health policy and practice was so broad that he was hailed as “the Dean of City Public Health Officials.”
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